STEP Up Ohlone mental health focus group RSVPs

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* 1. Contact information:

Name:

Email:

Cellphone (to receive a reminder):

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* 2. To which gender identity do you most identify?

Female

Male

Transgender female

Transgender male

Prefer not to answer

Other (please specify)

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* 3. We will hosting four focus groups. Please check your top two choices, assuming you meet the criteria:

	1st choice	2nd choice
Group 1: Fremont campus (Bldg 7, Counseling Dept. conference room): Monday, October 15, 1:00 PM - 2:00 PM (for deaf/hard of hearing students only)	Group 1: Fremont campus (Bldg 7, Counseling Dept. conference room): Monday, October 15, 1:00 PM - 2:00 PM (for deaf/hard of hearing students only) 1st choice	Group 1: Fremont campus (Bldg 7, Counseling Dept. conference room): Monday, October 15, 1:00 PM - 2:00 PM (for deaf/hard of hearing students only) 2nd choice
Group 2: Fremont campus (Bldg 7, Counseling Dept. conference room): Monday, October 29, 2:00 PM - 3:00 PM (open to all students)	Group 2: Fremont campus (Bldg 7, Counseling Dept. conference room): Monday, October 29, 2:00 PM - 3:00 PM (open to all students) 1st choice	Group 2: Fremont campus (Bldg 7, Counseling Dept. conference room): Monday, October 29, 2:00 PM - 3:00 PM (open to all students) 2nd choice
Group 3: Newark campus (NC 1100): Tuesday, October 30, 11:00 AM - 12:00 PM (for Asian & Pacific Islander students only)	Group 3: Newark campus (NC 1100): Tuesday, October 30, 11:00 AM - 12:00 PM (for Asian & Pacific Islander students only) 1st choice	Group 3: Newark campus (NC 1100): Tuesday, October 30, 11:00 AM - 12:00 PM (for Asian & Pacific Islander students only) 2nd choice
Group 4: Newark campus (NC 1100): Tuesday, October 30, 1:00 PM - 2:00 PM (open to any students)	Group 4: Newark campus (NC 1100): Tuesday, October 30, 1:00 PM - 2:00 PM (open to any students) 1st choice	Group 4: Newark campus (NC 1100): Tuesday, October 30, 1:00 PM - 2:00 PM (open to any students) 2nd choice