SALK Team: Free the Vaccine for COVID-19 Questionnaire

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This is an application to take part in the Free the Vaccine for COVID-19 Campaign, a global online Advocacy Innovation Lab to design, test, and deploy creative methods that pressure governments and pharmaceutical corporations. Our campaign aims to ensure publicly-funded diagnostic tools, treatment, and the COVID-19 vaccine will be sustainably priced, available to all and free at the point-of-delivery. More information about the project is here: https://c4aa.org/2020/03/join-us-free-the-vaccine-for-covid-19.

Applications are due April 1st 11:59pm EDT (but honestly, we're not going to be checking until later so sneak it in.)

Email *

I watched one of the Information Sessions *

We hosted two live information sessions about the campaign and offered recordings for those who couldn't attend live.

Yes

Part, but didn't finish

First Name *

Last Name *

City you are living/working in currently

Country you are living/working in currently

Can you tell us a little about yourself? 100-150 words.

Preferred pronoun

She

They

A pronoun not listed

No pronoun preference

Prefer not to say

Clear selection

Preferred Spoken / Written Language. Please indicate if you need interpretation services for English language presentations and documents.

Fluent in English

French is primary language, understand some English

Spanish is primary language, understand some English

Other:

Clear selection

Do you belong to any of the following?

Universities Allied for Essential Medicines staff / member / alumni

Staff, member or volunteer for another organization advocating for essential medicines

Center for Artistic Activism workshop alumni / Ministry member

None of the above

Other:

Would you describe yourself as (choose as many as apply):

Access to Medicines Activist

Human Rights Activist

Activist across multiple issues

I want to be an activist and am ready to learn more

Professional supporting social causes (eg. Communications professional helping advocacy orgs)

Artist/Designer/Creator

Academic, Researcher/Student

Medical Professional

Other:

Age

13-17

18-24

25-35

35-45

45-55

55-65

65+

Clear selection

Why do you want to be a part of this? Please choose ONLY your TOP THREE.

I want to fight for equal access to medicines and health care

I want to learn new skills for doing activism and advocacy

I enjoy collaborating with other people on creative and/or advocacy projects

I feel I can bring a realistic and critical perspective to this conversation

I want to channel my energy into something productive during this crazy global crisis

I want to share my knowledge and skills with other people who can learn from them

I don't know much about activism and I want to learn something new

Other:

In up to three sentences, please tell us a little more about why you are applying. What aspects of this project are you most interested in? What are you hoping to gain from it?

Can you commit to spending around 2 hrs a week to this project over the next few months?

Yes! I can definitely commit to spending at least 2 hrs a week for the next few months.

Maybe: I would like to, but honestly it could be a little tricky. I will try my best!

No but: I can't commit to 2 hours a week but is there a way I can be involved anyway?

Clear selection

Social Media account names (optional: this is just so we can be in touch later and connect with you online)

Any other questions or comments you want to add?

A copy of your responses will be emailed to the address you provided.

Submit

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