COVID-19 Vaccination Survey




Persons 16 years old and up are now eligible for the COVID-19 vaccine.

Certify your eligibility by clicking the down arrow below.


16 Years or Older Qualify for COVID-19 Vaccine





Learn more about eligible groups from the Wisconsin Department of Health Services website here.




Step 2: Who is your employer or to what organization do you belong?


Please select the employment status that best describes you:




Step 3: Your personal information