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VEAP Video Sign-Up
Help SCI's Teen VEAP program make a video to boost vaccination rates! If chosen you have the opportunity to receive a $50.00 Visa gift card for your participation
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* Indicates required question
What is your name?
*
Your answer
What is your email address?
*
Your answer
What is your phone number?
Your answer
Would you be willing to be recorded alongside your grandparents? (talking with them and our interviewer)
*
Yes
No
Maybe -- need more information
Do your grandparents live locally?
*
Yes
No
Would you be willing to share a photo or video of or alongside your grandparents?
Yes
No
Maybe -- need more information
Clear selection
Have you lost a family member to Covid-19?
Yes
No
Prefer not to say
Clear selection
If you answered "Yes", would you be willing to participate in a recorded video speaking about your loss?
Yes
No
Maybe - need more information
Clear selection
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