Focus Group Registration Survey

Thank you for your interest in participating in our focus group discussion. Please complete the following questions. We will get back to you shortly with additional details on the focus groups if you are selected to participate.

Please email rkupritz@outsourcemktng.com with any questions.

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1. Select all that apply:

Select all that apply: I am a parent of a home schooled Junior

I am a parent of a home schooled Senior

I am a home schooled Junior

I am a home schooled Senior

Other (please specify)

2. Which of the following applies to you/your child:

Which of the following applies to you/your child: Currently taking or have taken courses for college credit

Would consider taking courses for college credit but haven't taken yet

Not interested in taking courses for college credit

3. Please select which which of the following dates/times you would be available to participate in the 90 minute focus group (select all that apply). If none of these dates/times work for you, please let us know what days/times work best for you in the "Other" box:

Please select which which of the following dates/times you would be available to participate in the 90 minute focus group (select all that apply). If none of these dates/times work for you, please let us know what days/times work best for you in the "Other" box: Tuesday, April 27, 4:00 - 5:30 PM

Tuesday, April 20, 6:00-7:30 PM

Tuesday, April 27, 11:30-1:00 PM

Tuesday, April 27, 6:00-7:30 PM

Wednesday, May 5, 4:00-5:30

Other (please specify)

4. Who are you registering for the focus group?

Who are you registering for the focus group? Myself (I'm a parent)

Myself (I'm a student)

My child (I'm a parent)

Myself and my child (I'm a parent)

5. For parents registering as participants: Please provide the following information so we can contact you with additional information on the focus group.

For parents registering as participants: Please provide the following information so we can contact you with additional information on the focus group. Name:
Address:
City, State, Zip:
Phone:
Email

6. For students registering as participants or parents registering their children:

For students registering as participants or parents registering their children: Student Name:
Parent Name:
City, State, Zip:
Phone:
Parent e-mail:
Student e-mail:

Focus Group Registration
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1. Default Section

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1. Select all that apply:

2. Which of the following applies to you/your child:

3. Please select which which of the following dates/times you would be available to participate in the 90 minute focus group (select all that apply). If none of these dates/times work for you, please let us know what days/times work best for you in the "Other" box:

4. Who are you registering for the focus group?

5. For parents registering as participants: Please provide the following information so we can contact you with additional information on the focus group.

6. For students registering as participants or parents registering their children:

Focus Group RegistrationExit this survey

1. Default Section

*1. Select all that apply:

2. Which of the following applies to you/your child:

3. Please select which which of the following dates/times you would be available to participate in the 90 minute focus group (select all that apply). If none of these dates/times work for you, please let us know what days/times work best for you in the "Other" box:

4. Who are you registering for the focus group?

5. For parents registering as participants: Please provide the following information so we can contact you with additional information on the focus group.

6. For students registering as participants or parents registering their children:

Focus Group Registration
Exit this survey

*
1. Select all that apply: