Caregiver Focus Group Recruitment

Jump at the Sun Consultants - Helping Communities Reach New Heights

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Cessation
Same Game Different Smokers
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No Menthol Sunday
Truth Check
Media

Caregiver Recruitment

Thank you for responding to our request. We are currently recruiting caregivers (foster parent, grandparent, aunt, uncle, etc.) of African American youth (5-12th grade) in Milwaukee and Ozaukee Counties.

Please complete the following form to confirm your interest and availability. A representative will call to confirm your participation in a scheduled focus group discussion.

* Indicates required field

First Name *

Last Name *

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

How many children do you have? *

How old is each child? *

What is their gender? *

Grade (Please check one) *

5th-8th grade 9th-12th grade

Check the one that best describes you *

Current Smoker or e-cigarettes Former Smoker or e-cigarettes Never Smoked or used e-cigarettes

In a group setting with people you don't know which one is describes you the best: *

Active listener that rarely engages in the conversation Active listener that comfortably engages in conversation Occassionally dominates the conversation

Which best describes you in a group setting with people you don't know: *

Reserved and/or reluctant to share my opinions and thoughts Comfortable initiating a free flowing conversation. Comfortable sharing my opinion and thoughts after some reflection. More likely only to share my thoughts and opinions if I am called on.

Date (Please select one) *

Friday July 24th 1:00 - 2:30 Caregiver (foster parent, grandparent, aunt, uncle, etc.) of child in grades 9th - 12th Friday August 14th 1:00 - 2:30 Caregiver (foster parent, grandparent, aunt, uncle, etc.) of child in grades 5th - 8th

Confirm your access to one of the following: *

Mobile phone with mic and camera for video Computer with mic and camera for video

Submit

Caregiver Recruitment

WE WOULD LOVE TO WORK WITH YOU!