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Copy of Focus Group Application
1.
What is your First and Last name?
2.
What is your email address?
3.
What is your gender?
Female
Male
Other (specify)
4.
What is your age?
5.
Where do you currently live?
6.
What is your current occupation?
7.
What is the highest level of school you have completed or the highest degree you have received?
Less than high school degree
High school degree or equivalent (e.g., GED)
Some college but no degree
Associate degree
Bachelor degree
Graduate degree
8.
Are you White, Black or African-American, Hispanic, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?
White
Black or African-American
Hispanic
American Indian, Alaskan Native, Native Hawaiian or other Pacific Islander
Asian
Middle Eastern
From multiple races
Some other race (please specify)
9.
What, if any, Latino group do you consider yourself part of?
I am not Spanish, Hispanic, or Latino
Mexican
Caribbean
Central American
Spanish South American
Brazilian
Some other Spanish, Hispanic, or Latino group
From multiple Spanish, Hispanic, or Latino groups
10.
Have you ever participated in a focus group before?
Yes
No