Youth-Serving Organizations

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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!