A Conversation with Dr. Barbara Ferrer and Dr. Muntu Davis Event Question Submission Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Friday, Jan. 28th, 2022
5:00pm

Please join us as we discuss the state of the COVID-19 pandemic, how community partners serve as the backbone of the County response, and ways to continue to build towards a more equitable recovery.

COVID-19 Response Community Initiative [Select all that apply] *

Community Health Worker Outreach Initiative

COVID-19 Community Equity Fund

Public Health Councils

CDPH WeVax or Regional Roundtables

Faith-based partner

Grassroots Grant or School Mini Grant Recipient

Other:

Required

Organization Name *

First and Last Name

Email Address

What area of LA County do you support? *

Antelope Valley

East LA

Long Beach

North East LA

Pasadena

San Fernando Valley

San Gabriel Valley

South Bay

South Central LA

South East LA

West LA

Other:

Required

Question #1:

Question #2:

Question #3:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms