JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Student Vaccine Interest
Sign in to Google
to save your progress.
Learn more
Are you interested in receiving a COVID-19 vaccination?
Yes
No
Maybe
Clear selection
Age group
16-19 years old
12-15 years old
Other
Prefer not to answer
Clear selection
County you live in?
Antelope
Boyd
Brown
Cherry
Holt
Keya Paha
Knox
Pierce
Rock
Other:
Clear selection
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
Forms
