Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

How has COVID-19 impacted you?

  1. COVID-19 has completely changed our world. How has it impacted you? Some have lost their job and are dealing with financial uncertainty. Others have lost a loved one. This virus has impacted all of us in some way. The City of Dubuque wants to hear how the COVID-19 pandemic has impacted you. After completing this form, one of our team members may contact you to discuss sharing your story with the community. No information will be shared without your consent, and our team will work with you to ensure your story is told accurately and in a way that is comfortable for you. Through sharing these stories, we hope to cultivate a greater understanding of how the pandemic is directly impacting so many in our community.
  2. Are you a resident of Dubuque County?*
  3. How have you been impacted by COVID-19? *
  4. Which of the following would you be comfortable with doing to share your story?*
  5. Thank you for sharing your experience. Your story will not be shared without your consent, and a City employee may be in contact soon to help you share your story in a way you feel comfortable with. If you have questions, please email City of Dubuque Communications Assistant Trevor Fannon at tfannon@cityofdubuque.org.
  6. Leave This Blank: