Please verify for your information for your study – Washington, 6/12, 6/13, 6/14, 6/18

"*" indicates required fields

Name*

First Last

Email*

Please enter the email you have with us.

Enter Email Confirm Email

Best Contact Phone Number*

What is the best number to contact you at via phone?

What year were you born*

Enter the year you were born, like 1999 or 1972.

Please enter a number from 1900 to 2050.

Gender*

Which best describes the gender to which you most identify?

-- SELECT BELOW --MaleFemaleTransgender FemaleTransgender MaleGender Variant or Non-Conforming

Which County*

Which US County, Parish, or Township do you live in?

-- SELECT BELOW --AdamsAsotinBentonChelanClallamClarkColumbiaCowlitzDouglasFerryFranklinGarfieldGrantGrays HarborIslandJeffersonKingKitsapKittitasKlickitatLewisLincolnMasonOkanoganPacificPend OreillePierceSan JuanSkagitSkamaniaSnohomishSpokaneStevensThurstonWahkiakumWalla WallaWhatcomWhitmanYakimaAnother county not listed

Race/Ethnicity*

What is your race or ethnicity? If you are mixed race, select all races you represent.

African American

Asian

Caucasian

Hispanic or Latino

Middle Eastern

Native American or Alaskan Native

Pacific Islander or Native Hawaiian

Some Other Race

Education*

Which best describes the highest level of education you have had the opportunity to complete?

-- SELECT BELOW --Some high schoolGEDHigh schoolSome college (no certificate)Associates degreeTechnical schoolBachelors degreeSome post graduatePost graduate degree

Political Leaning*

Typically do you consider yourself more of a Democrat, Republican or something else? Even if you don't vote, how do you think about public policy?

-- SELECT BELOW --Strong DemocratIndependent leaning DemocratIndependentIndependent leaning RepublicanStrong RepublicanLiberalModerateConservative

Elections Voting In*

What Elections do you usually vote in? Select all that apply.

General Elections (usually held in November)

Primary Elections

Local Elections

Special Elections

Not Registered or Do Not Vote

Not Eligible to Vote

Occupations*

Do you work in, or have any training in any of the following industries or fields? Select all that apply.

Banking or Finance Fields

Education Fields

Government Fields

Health Insurance Fields

Law Enforcement Fields

Legal Fields

Marketing and Communications Fields

Medical Fields

Mental Health Fields

Military Fields

News and Media Fields

Political Fields

None of the Above

Children at Home*

Do you have any children under the age of 18 at home?

Yes

No

Marital Status*

Which best represents your current marital status?

-- SELECT BELOW --DivorcedLiving with PartnerMarriedSingleWidowed

Household Income*

Which category best represents your family's total household income, before taxes annually?

-- SELECT BELOW --Under $20K$20-$35K$35-$50K$50-$80K$80-$100K$100-$150K$150-$250K$250K or more

Home Ownership*

Own

Rent

I have a different arrangement

Employment Status*

Which best describes your current employment status?

-- SELECT BELOW --Full-timePart-timeSelf-EmployedHomemakerRetiredUnemployedStudentDisabled

Payment Preference*

How would you like to receive your participation incentive? Digital payments are sent to the email address we have on file for you.

-- SELECT BELOW --AmazonCash AppCheckPayPalVenmo

Address*

Please enter your mailing address so we can mail you your study information in addition to the email information you will receive from us. Include your CITY, STATE, and ZIP CODE as well.

Zoom*

This focus group will be completed online using your personal computer and webcam using a web meeting tool called Zoom. You must have reliable high speed internet access that you can use for the entire session, a quiet place to join the study from, and a computer or laptop with a webcam for use. When was the last time you joined an online meeting lasting for more than 30 minutes via your computer with your enabled webcam from Zoom?

Within the last 6 months

More than 6 months ago

I have never joined a Zoom, but I have a computer with a webcam to join from

I do not have a computer with a webcam I can join a Zoom meeting from

If you have not used Zoom recently you will be redirected to our Calendly to schedule a technology check. Please select a time that is convenient for you within the next few days to ensure that we complete your webcam verification in a timely manner and get you your Zoom link with plenty of time to prepare.

Email

This field is for validation purposes and should be left unchanged.

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