Testing form – Covid-19 Indigenous

Share Your Story

What do you want to share with us? *

Written Story
Photo
VIdeo

Your COVID-19 Story

Name *

First

Last

Community/Town/City *

*Phone Number *

*Email

One of either email or mailing address required.

* Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Your Story *

Describe Your Photo

Add your photo *

Click or drag a file to this area to upload.

Describe your photo *

Name *

First

Last

Community/Town/City *

*Phone Number *

*Email

One of either email or mailing address required.

*Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Describe Your Video

Add your video *

Click or drag a file to this area to upload.

Describe your video *

Name *

First

Last

Community/Town/City *

*Phone Number *

*Email

One of either email or mailing address required.

*Mailing Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

*We would like to include your name and community when we publish your submission, but your phone number/email/mailing address will be kept private.