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COVID Community Corps Weekly Outreach Log

The COVID Community Corps Outreach Log will enable us to track the impact of your work and the entire corps. The information you share below is essential to our ability to support you in reaching New Jersey residents and accomplishing our goal of connecting with 1000 New Jersey residents a week. Please make sure to fill out the information as accurately as possible and to submit completed logs on a weekly basis.
Full Name  ✱
Date of submission ✱
(mm/dd/yyyy)
Email  ✱
If applicable, affiliated organization:
Number of people you've educated on COVID-19 and the vaccine  ✱
What feedback did you received in conversations?
Were there any consistent themes?
Number of people you’ve pre-registered for a vaccine appointment ✱
(Individuals you've registered through the NJVSS or direct booking vaccination systems)
Were there any challenges during the pre-registration process?
Number of people you’ve confirmed vaccination appointments for ✱
(Individuals who have a scheduled date/time/location for a vaccine)
Were there any challenges during the registration process?
Which municipalities are represented in your outreach efforts?  ✱
Select all that apply
0ebd24b47a804e1a9faffe7af9b59162 Atlantic 
0ebd24b47a804e1a9faffe7af9b59162 Bergen 
0ebd24b47a804e1a9faffe7af9b59162 Burlington 
0ebd24b47a804e1a9faffe7af9b59162 Camden 
0ebd24b47a804e1a9faffe7af9b59162 Cape May 
0ebd24b47a804e1a9faffe7af9b59162 Cumberland 
0ebd24b47a804e1a9faffe7af9b59162 Essex 
0ebd24b47a804e1a9faffe7af9b59162 Gloucester 
0ebd24b47a804e1a9faffe7af9b59162 Hudson 
0ebd24b47a804e1a9faffe7af9b59162 Hunterdon 
0ebd24b47a804e1a9faffe7af9b59162 Mercer 
0ebd24b47a804e1a9faffe7af9b59162 Middlesex 
0ebd24b47a804e1a9faffe7af9b59162 Monmouth 
0ebd24b47a804e1a9faffe7af9b59162 Morris 
0ebd24b47a804e1a9faffe7af9b59162 Ocean 
0ebd24b47a804e1a9faffe7af9b59162 Passaic 
0ebd24b47a804e1a9faffe7af9b59162 Salem 
0ebd24b47a804e1a9faffe7af9b59162 Somerset 
0ebd24b47a804e1a9faffe7af9b59162 Sussex 
0ebd24b47a804e1a9faffe7af9b59162 Union 
0ebd24b47a804e1a9faffe7af9b59162 Warren 
Are any of the following municipalities represented in your outreach efforts? ✱
Select all that apply
0ebd24b47a804e1a9faffe7af9b59162 Atlantic City 
0ebd24b47a804e1a9faffe7af9b59162 Bayonne City 
0ebd24b47a804e1a9faffe7af9b59162 Bridgeton City 
0ebd24b47a804e1a9faffe7af9b59162 Camden City 
0ebd24b47a804e1a9faffe7af9b59162 Carteret Borough 
0ebd24b47a804e1a9faffe7af9b59162 City of Orange 
0ebd24b47a804e1a9faffe7af9b59162 Cliffside Park Borough 
0ebd24b47a804e1a9faffe7af9b59162 Dover Town 
0ebd24b47a804e1a9faffe7af9b59162 East Orange City 
0ebd24b47a804e1a9faffe7af9b59162 Elizabeth City 
0ebd24b47a804e1a9faffe7af9b59162 Freehold Borough 
0ebd24b47a804e1a9faffe7af9b59162 Guttenberg Town 
0ebd24b47a804e1a9faffe7af9b59162 Hackensack City 
0ebd24b47a804e1a9faffe7af9b59162 Haledon Borough 
0ebd24b47a804e1a9faffe7af9b59162 Harrison Town 
0ebd24b47a804e1a9faffe7af9b59162 Irvington Township 
0ebd24b47a804e1a9faffe7af9b59162 Jersey City 
0ebd24b47a804e1a9faffe7af9b59162 New Brunswick City 
0ebd24b47a804e1a9faffe7af9b59162 Newark City 
0ebd24b47a804e1a9faffe7af9b59162 North Bergen Township 
0ebd24b47a804e1a9faffe7af9b59162 Passaic City 
0ebd24b47a804e1a9faffe7af9b59162 Paterson City 
0ebd24b47a804e1a9faffe7af9b59162 Plainfield City 
0ebd24b47a804e1a9faffe7af9b59162 Pleasantville City 
0ebd24b47a804e1a9faffe7af9b59162 Prospect Park Borough 
0ebd24b47a804e1a9faffe7af9b59162 Red Bank Borough 
0ebd24b47a804e1a9faffe7af9b59162 Trenton City 
0ebd24b47a804e1a9faffe7af9b59162 Vineland City 
0ebd24b47a804e1a9faffe7af9b59162 West New York Town 
0ebd24b47a804e1a9faffe7af9b59162 Woodbury City 
0ebd24b47a804e1a9faffe7af9b59162 None of the above 
Which vulnerable populations did you educate and engage?
9292a4b4fd9f4d08ae12f94ff90ca254 Black communities/African American  
9292a4b4fd9f4d08ae12f94ff90ca254 Hispanic/Latinx  
9292a4b4fd9f4d08ae12f94ff90ca254 Veterans  
9292a4b4fd9f4d08ae12f94ff90ca254 Homeless 
9292a4b4fd9f4d08ae12f94ff90ca254 Homebound  
9292a4b4fd9f4d08ae12f94ff90ca254 Disabled  
9292a4b4fd9f4d08ae12f94ff90ca254 Pregnant and nursing mothers  
9292a4b4fd9f4d08ae12f94ff90ca254 Tribal nations  
9292a4b4fd9f4d08ae12f94ff90ca254 South Asian  
9292a4b4fd9f4d08ae12f94ff90ca254 Orthodox Jewish  
9292a4b4fd9f4d08ae12f94ff90ca254 Undocumented  
9292a4b4fd9f4d08ae12f94ff90ca254 Migrant workers  
9292a4b4fd9f4d08ae12f94ff90ca254 Seniors 
9292a4b4fd9f4d08ae12f94ff90ca254 None of the above