"Reflect, Alabama": Alabamians in the time of COVID-19 Registration
Please complete the following registration. We will provide access to the breakout session prior to June 18, 5:30p via your shared email.
Sign in to Google to save your progress. Learn more
What is your email address? *
What is your name?
Feel free to make up a name. (Please be appropriate.)
What is your ZIP code at your home address? *
Each breakout room on June 18, 2020 will be centered around one of the following themes. Please rank the areas of interest from most to least interesting to you. You will be assigned a breakout room based on your preferences and other demographic information. *
1st Choice, Most Preferred
2nd Choice
3rd Choice
4th Choice
5th Choice, Least Preferred
Role of Public Health in responding to a pandemic
Role of Education in responding to a pandemic
Role of Community in responding to a pandemic
Role of Government in responding to a pandemic
Role of Journalism in responding to a pandemic
Please select your age group. *
With the understanding that we're all young at heart.
Please indicate your gender: *
Which best describes your religious affiliation? *
Please select your highest level of education: *
Are you of Hispanic, Latino, or Spanish origin? *
How would you describe yourself? Check all that apply. *
Required
Which of the following categories best describes the industry you primarily work in (regardless of your actual position)? *
Next
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