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2. 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.
4. First Name*
5. Last Name*
7. Email*
8. Phone*
10. Are you a resident of Dubuque County?*

    1. Yes
    2. No
12. How have you been impacted by COVID-19? *

    1. I have had COVID-19.
    2. I know someone and/or have cared for someone who has had COVID-19.
    3. I know someone and/or have cared for someone who has lost their life to COVID-19.
    4. I have lost my job and/or my job has changed significantly due to COVID-19.
    5. I have suffered financial burdens due to COVID-19.
    6. I am a teacher, healthcare worker, or frontline worker impacted by COVID-19.
    7. I am a parent whose child’s education is impacted by COVID-19.
    8. Other.
14. Tell us more about how you have been impacted: (your response will not be used without your consent.)
16. Which of the following would you be comfortable with doing to share your story?*

    1. Written testimonial
    2. Audio testimonial
    3. Video testimonial
18. 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.
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