COVID-19 Awareness Course Application Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

How old are you?

What is your gender?

What is your country of origin?

Where do you reside at the moment?

Where did you first hear about COVID-19?

What do you think is the most effective way to prevent the spread of COVID-19 virus?

What would you do to help our Health Care Professionals battle the spread of COVID-19 or Coronavirus?

Follow all strict health protocols in your area.Help spread awareness to other people by sharing vital information to our community.Stay alert and be cautious all the time.

Are you willing to wear Personal Protective Equipment (PPE), face shield or other additional protection when going out?

YesNoNot sure

Choose the symptoms of COVID-19 that you are aware of?

Do you think that your country's Health Care Facility can accommodate all COVID-19 patients?

YesNoNot sure

Do you think that our Nation’s Health Care System can withstand the COVID-19 crisis we are facing?

YesNoNot sure