Charlottesville & Albemarle County Litter & Plastic Pollution Reduction Campaign – Focus Group Interest Form

Thank you for your interest in participating in a focus group for the Charlottesville & Albemarle County Litter & Plastic Pollution Reduction Campaign.

We are looking for a mix of people who live, work, study, volunteer, or spend time in Charlottesville and Albemarle County. Your responses will help us bring together participants with a range of experiences and perspectives. Please answer based on your own experience.

Please submit your completed survey by Friday, October 23, 2026.

Estimated time: 5–7 minutes
1.Please provide your name.(Required.)
2.Please provide your email address.(Required.)
3.Please provide your phone number.(Required.)
4.What is your connection to Charlottesville and/or Albemarle County? (Select all that apply)
5.Which of the following 90-minute virtual focus group sessions are you available to attend? (Select all that apply)(Required.)
6.What is your age range?
7.What is your gender identity?
8.What is your current employment status?
9.Which of the following best describes your race or ethnicity?
10.What is your approximate annual household income?
11.What ZIP code, neighborhood, or community do you live or spend the most time in?(Required.)
12.If you live in Charlottesville or Albemarle County, which best describes where you live?
13.Which of the following best describes how you experience or interact with the community? (Select all that apply)
14.How often do you notice litter or plastic pollution in the places where you live, work, study, or spend time?
15.Where do you notice litter or plastic pollution most often? (Select all that apply)
16.Have you experienced any of the following where you live or spend time? (Select all that apply)
17.Have you participated in any of the following during the past two years?
18.Do any of the following make it difficult for you to participate in community meetings, events, or activities? (Select all that apply)(Required.)
19.Have you participated in a focus group, interview, or community discussion about litter, waste, recycling, or environmental issues in Charlottesville or Albemarle County within the past year?
20.Which of the following describe your current living situation?
Thank you for your interest in participating. We’ll review the responses and contact those selected to participate by end of day Friday, October 23, 2026, with additional details about the focus group.

We appreciate your interest in helping shape the Charlottesville & Albemarle County Litter & Plastic Pollution Reduction Campaign.