NJ CCC Volunteers Sign up

NJ COVID COMMUNITY CORP: Vaccination events

Join us in raising awareness about local vaccination sites and help residents schedule vaccine appointments in areas with low coverage. Every knock and every conversation would help us move closer to our goal.

If you have not signed up to be a member of the NJ COVID Community Corps and completed the required trainings, please do so HERE. The trainings should take approximately 1 hour to complete.

The survey takes approximately 5 minutes to complete. If you have any question, please email me at Nayeli.Salazar@doh.nj.gov

First name ✱
Last name ✱
Email ✱
Phone number (Mobile) ✱
What is your age group?
0ebd24b47a804e1a9faffe7af9b59162 18-24 
0ebd24b47a804e1a9faffe7af9b59162 25-34 
0ebd24b47a804e1a9faffe7af9b59162 35-44 
0ebd24b47a804e1a9faffe7af9b59162 45-54 
0ebd24b47a804e1a9faffe7af9b59162 55-64 
0ebd24b47a804e1a9faffe7af9b59162 65-74 
0ebd24b47a804e1a9faffe7af9b59162 75 years and older 
Are you:
0ebd24b47a804e1a9faffe7af9b59162 Male 
0ebd24b47a804e1a9faffe7af9b59162 Female 
0ebd24b47a804e1a9faffe7af9b59162 Transgender 
0ebd24b47a804e1a9faffe7af9b59162 Genderqueer 
0ebd24b47a804e1a9faffe7af9b59162 Other 
What is your race / ethnicity
Select all that apply
cd97703d4f1d423c883f95aafb9e8593 Black/African 
cd97703d4f1d423c883f95aafb9e8593 Hispanic/Latino/Latinx 
cd97703d4f1d423c883f95aafb9e8593 White/Caucasian 
cd97703d4f1d423c883f95aafb9e8593 American Indian 
cd97703d4f1d423c883f95aafb9e8593 Asian 
cd97703d4f1d423c883f95aafb9e8593 Other 
Do you speak
cd97703d4f1d423c883f95aafb9e8593 Spanish 
cd97703d4f1d423c883f95aafb9e8593 Arabic 
cd97703d4f1d423c883f95aafb9e8593 French 
cd97703d4f1d423c883f95aafb9e8593 Gujarati 
cd97703d4f1d423c883f95aafb9e8593 Haitian Creole 
cd97703d4f1d423c883f95aafb9e8593 Hindi 
cd97703d4f1d423c883f95aafb9e8593 Italian 
cd97703d4f1d423c883f95aafb9e8593 Mandarin 
cd97703d4f1d423c883f95aafb9e8593 Polish 
cd97703d4f1d423c883f95aafb9e8593 Portuguese 
cd97703d4f1d423c883f95aafb9e8593 Tagalog 
cd97703d4f1d423c883f95aafb9e8593 Other 
What county do you currently reside in? ✱
Please select the city, town, or municipality where you live ✱
If you cannot find your city, please select "Other" and type in your location
Select your preferred volunteer location for special events July 17th weekend
cd97703d4f1d423c883f95aafb9e8593 Sat, July 17- Christ Church in New Brunswick, 10AM-1PM 
cd97703d4f1d423c883f95aafb9e8593 Sat, July 17- St. Mark's Church in Keansburg, 10AM-1PM 
cd97703d4f1d423c883f95aafb9e8593 Sat, July 17- Ocean Health Initiative in Lakewood, 9AM-1PM 
cd97703d4f1d423c883f95aafb9e8593 Sun, July 18- Parish of Our Lady of Angels in Trenton, 9:30AM-12:30PM