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miRcore Vaccine Advocacy Sign-Up Form
Help fight COVID-19 by becoming a vaccine advocate!
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Email
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Your email
First Name:
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Your answer
Last Name:
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Your answer
Phone number:
Your answer
Address
Your answer
Grade (2021-22 School Year)
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9th
10th
11th
12th
College
College graduates
Other:
Where did you hear about this vaccination campaign?
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MVP meetings/contact
miRcore summer camps
GIDAS club meetings/contact
Friends and Family
Independent online encounter (Instagram, Snapchat, Emails)
Other:
Required
Newsletter sign up: By opting in, you will receive weekly newsletters with time-sensitive matters including upcoming MVA trainings and updated COVID-19 information.
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Yes
No
Advocacy: which tasks would you like to commit to?
I will share the information using my personal online connections.
I want to be trained to talk to my friends and family.
I will create my own materials and share them with MVA.
I want to join a committee to plan MVA and prepare materials together.
Other:
If interested, select a committee to join (Commitment: weekly meetings to discuss and prepare for better MVA)
Content Reviewers/Curators/Writers (From other resources)
Empathy Trainers
Social Media Creators/Graphic Artists
Administrative/Logistical Community Organizers
Any other comments/questions?
Your answer
A copy of your responses will be emailed to the address you provided.
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