Survey: Faith Communities & Vaccine Administration in the USA
This survey is intended solely for religious institutions, houses of worship, or faith-based organizations which have utilized their house of worship as a vaccination site.

Faiths4Vaccines is an inclusive, multi-faith movement comprised of local and national religious leaders, as well as medical professionals, who are working together to identify and resolve current gaps in vaccine mobilization, outreach, and uptake. Therefore, the initiative seeks to increase opportunities for faith-based institutions, particularly houses of worship, to engage and support the United States government in its efforts to increase vaccination rates through the advancement of equitable vaccine distribution and combat vaccine hesitancy.

The findings from this survey will be will be shared at Faiths4Vaccines Summit on May 26 to amplify the critical role and capacities of faith leaders to advance equitable distribution and serve as trusted messengers to decrease vaccine hesitancy.

**Please ensure that only one person from your organization completes this form.

Sign in to Google to save your progress. Learn more
Your name (Be assured that your responses will remain anonymous) *
House of Worship or Faith Organization represented *
Your title or role in this organization
Your email address *
ZIP Code where your organization is based *
What is your institution's religious affiliation or denomination? *
If you'd like to give us more specific details on your denomination, or if you answered "Other," please include it here.
How many members does your organization have? *
How many doses of vaccines have been distributed by your organization? (Approximate total number of ALL Pfizer or Moderna first AND second doses, plus ALL Johnson & Johnson doses) *
To what extent were vaccines administered to individuals who were members of your organization?
None were members
All were members
Clear selection
Who did you partner with to distribute the vaccines? *
Did you already have a relationship with the health care partner mentioned in the previous question? *
To what extent were vaccine-hesitant individuals more willing to receive the vaccine because your faith-based organization offered it? *
Not at all (Faith-based organization was not a factor)
Completely (They chose our site because it is a faith-based organization)
What else would you like to tell us? Do you have a story of someone who overcame vaccine hesitancy because of your organization's work? Were your members or local community engaged by your work?
Would like to receive updates from Faiths4Vaccines?
Clear selection
Thank you for taking the time to complete this survey.  
If you have any questions, please contact us at information@faiths4vaccines.org or visit www.faiths4vaccines.org
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms