*1.Full Name(Required.)

*2.Email address(Required.)

*3.Phone number(Required.)

*4.Age Range
*You must be at least 18 to participate(Required.)

18-24

25-34

35-44

45-54

55-64

65+

*5.Commitment to Attend

There will be two small-group listening sessions. Please select the session you would be available to attend.

☐ Session 1 – Backyard BBQ | Tuesday, March 25th, 5:00 PM
☐ Session 2 – Roosevelt Library | Thursday March 26th, 5:00 PM
☐ I am flexible and can attend any session

Participants selected for a session will receive a confirmation with location details.(Required.)

Yes, I plan to attend the March 25, 5:00 PM session at Backyard BBQ

Yes, I plan to attend the March 26, 5:00 PM session at Roosevelt Library

I am flexible and can attend either session as needed (we will contact you to confirm).

No, I am not able to attend either session

*6.Privacy & Group Discussion Notice

This listening session may include discussion of personal experiences and perspectives. Information shared during the discussion may be summarized and included in reports, planning documents, or internal records to help inform community initiatives.

Facilitators will make reasonable efforts to protect participant privacy when summarizing insights. However, because this discussion takes place in a group setting, complete confidentiality cannot be guaranteed.

Participants will be asked to respect the privacy of others and not share personal stories, names, or identifying information outside of the group.

Given this information, would you still like to participate in a listening session?(Required.)

Yes, I would like to participate

No, I prefer not to participate

*7.Participation Consent

This community-focused campaign is about putting our community at the center of the conversation and the solutions. By listening to residents, elevating local voices, and inviting people to be part of the process, we aim to build solutions that reflect the everyday needs and experiences of the people we serve.

By participating in this listening session, you acknowledge that your perspectives and experiences may help inform future planning, community initiatives, and policy discussions. Insights from the conversation may be summarized in reports or internal documentation, but individual comments will not be attributed by name.

Participation is voluntary, and you may choose to pass on any question during the discussion.

Do you consent to participate under these conditions?(Required.)

Yes, I consent to participate

No, I do not consent

*8.Session Format

The listening session will be a facilitated small-group conversation lasting approximately 90 minutes.

Facilitators will guide the discussion by asking questions related to several topic areas. Participants may share their perspectives verbally during the group discussion or provide written responses if they prefer.

To ensure everyone has an opportunity to contribute, facilitators may occasionally invite participants to share responses in turn. Participants are always free to pass on any question.

Are you comfortable participating in this discussion format?(Required.)

Yes

No

*9.Participation Guidelines

To create a respectful and productive discussion environment, participants will be asked to follow these guidelines:

• Respect the privacy and confidentiality of others in the group
• No audio recording, video recording, photography, or wearable recording devices (including smart glasses)
• Phones should be silenced during the session
• Avoid side conversations so everyone can hear and participate
• One person speaks at a time
• Keep responses reasonably concise so everyone has the opportunity to contribute
• Participants may pass on any question
• Respect different experiences and viewpoints

Do you agree to follow these participation guidelines?(Required.)

Yes

No

*10.Discussion Topics (Overview)

The conversation will explore several areas related to everyday life in the community. Participants may share experiences, concerns, and ideas related to topics such as:

Affordability
Housing, healthcare costs, education, childcare, daily expenses, and economic security.

Quality of Life
Public health, safe communities, work-life balance, strong schools, and reliable infrastructure.

Hope & Opportunity
Economic mobility, small business growth, fairness, accountability, and building a strong future for the community.

Are you comfortable sharing your perspectives on these types of topics?(Required.)

Yes

No

11.What interested you in participating in this listening session?

12.Are there specific topics or experiences you hope will be discussed?

13.Is there anything the facilitators should know that would help you feel comfortable participating?

14.Future Engagement (Optional)

May we contact you about future community discussions, surveys, or listening sessions?

Yes

No