Mohave, AZ Project – Jessica Jenkins & Associates

Participant Form

Mohave, AZ Focus Group!

Thank You for your interest in participating in our current Focus Group specifically designed for Mohave, AZ Residents! Your thoughts and opinions are valuable, and we hope to be in touch soon! Please fill out this form and, if selected, we’ll be reaching out to you soon to get you enrolled into the Focus Group.

Participant Info

First Name^*

Last Name^*

Age^*

Ethnicity^*

Highest Level Of Education^*

Employment Status

Job Title

Contact Details

Email^*

Phone Number^*

Secondary Phone Number

Location

City ^*

State or Region ^*

Country

Zip ^*

County

Study Demographics

Your Preferred Political Party^*

Are You Currently A Full Time Student?^*

Your Current Marital Status^*

Have you ever served on a jury?

In the past YEAR - have you participated in a focus group discussion or legal research study?^*

Do you have a laptop or desktop computer with a webcam, to join an online focus group meeting? (No cell phones / tablets / Chromebooks)^*

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Participant Form

Mohave, AZ Focus Group!

Participant Info

Contact Details

Study Demographics

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