Caregiver Focus Group Recruitment

Caregiver

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

Grade (Please check one) *

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

Date (Please select one) *

Friday July 10th - 1:00 - 2:30 Caregiver (foster parent, grandparent, aunt, uncle, etc.) of child in grade 5th - 8th Friday July 10th - 5:00 - 6:30 Caregiver (foster parent, grandparent, aunt, uncle, etc.) of child in grades 9th - 12th

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

We Would Love to WORK WITH You Soon!