TBRHSC is currently recruiting participants for focus groups for the Black Health Action Plan. If you wish to participate in the study, please fill out the brief questionnaire below.
Identity Questions

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* 1. Do you identify as Black, African, Afro-Caribbean, or as a member of the African diaspora?

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* 2. Which Black community or communities do you identify with? (check all that apply):

Linguistic Variable Questions

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* 3. What is your mother tongue?

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* 4. If your mother tongue is neither English nor French, in which of Canada's official languages are you most comfortable?

Availability and Contact Information

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* 5. Please indicate your availability using the table below. Check all dates and times that apply.

  Morning (9 am - 12 pm) Afternoon (12 - 4 pm) Evening (4 - 8 pm) Other or Varies
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 6. Please provide your name.

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* 8. Please provide your phone number so we can keep in touch and let you know when the focus groups will take place.

Thank you for taking the time to complete this survey. Your responses are appreciated!

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