Youth-Serving Organizations

Jump at the Sun Consultants - Helping Communities Reach New Heights

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Cessation
Same Game Different Smokers
My Menthol Story
No Menthol Sunday
Truth Check
Media

Youth Serving Organization Educators

We are currently recruiting program directors, coordinators, teachers, coaches, and others that work with 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

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 Ocassionally 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.

Grade (Please check one) *

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

Date (Please select one) *

Tuesday July 28th 1:00 - 2:30 Educator of students in 5th - 8th grade Friday July 29th 2:00 - 3:30 Educator of students in 5th-12th grade Tuesday August 18th 1:00 - 2:30 Educators of students in 9th-12th grade

Confirm your access to one of the following: *

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

Submit

Youth Serving Organization Educators

WE WOULD LOVE TO WORK WITH YOU!