Fatherhood Program Interest Form
Thank you for your interest in participating in this discussion. These focus groups are part of a process to develop a program to help support fathers who do not have primary custody of their children.  The discussion will be led by UW-Extension Educators or a graduate student and the information will only be used to create future programming around parenting and fatherhood.

We want to engage fathers from the beginning of the program and have them help tell us what they need and how to best evaluate or determine if the program is helpful or “works”. Fathers who participate in a 1 to 1.5 hour focus group discussion will be compensated for their time. The discussions will be recorded, but will remain confidential. Participant feedback will remain anonymous, and participation in the group will not positively or negatively affect any child support case that a participant currently has with a county or tribal child support agency.  

The purpose of this form is to gather some information from you in order to best prepare these focus groups to fit the needs and expectations of the fathers who will be joining, as well as to gather demographic information.

Someone from the research team will contact you after you complete this form, but it may take a few days to get back to you. With any questions, please contact focusonfathers@sohe.wisc.edu. 
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Full Name *
Email *
Please provide a phone number where you can be reached: *
What is the best way to contact you? (Select all that apply) *
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What is your preferred language? *
In what county do you currently live? *
Below we have listed possible dates and times to hold focus groups. Please check all options that work for your schedule.

If the times listed below do not work for you, that's okay. We may schedule more sessions or find another way to hear from you.
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Where did you hear about this opportunity? *
Recruiter's name (if applicable):
To show that you are a real person (and not spam), what is your favorite food? *
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