Interest Form: Conducting Participatory Action Research in Academia and the Community

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Jonathan M. Tisch College of Civic Life, Tufts University
Date: July 2021
Location: Zoom
Contact: Dr. Anjuli Fahlberg, anjuli.fahlberg@tufts.edu

Email *

Please respond to the following questions so we know who you are and why you are interested in this course. This will help us tailor the course to participants' interests and needs. Please note we may not have room for all applicants. You will be contacted within 2-3 weeks after form submission. Additional information about enrollment, meeting times and locations will be sent to those who have filled out the interest form.

Name (First and last): *

Preferred gender pronouns

With which racial/ethnic/national communities do you identify?

Email *

Phone number: *

Organization(s) & location: *

Which category best describes you? (select all that apply): *

Undergraduate student w/ planned data collection project

Grad student (Master's) w/ planned data collection project

Grad student (PhD)

Post-doc or faculty

Administrator/program director at community-based organization

Researcher/data analyst at community-based organization

Service provider, activist or volunteer at community-based organization

Administrator/program director in public agency

Researcher/data analyst in public agency

Other:

Required

Why are you interested in this course? *

Briefly describe what research you are thinking of conducting. (If you're not sure, just describe some general ideas/questions) *

Who is the target population of the research project? What experiences/relationships do you or your organization already have with them?

What previous training and experience do you have conducting research/data collection/evaluation/assessments?

Do you plan to bring other colleagues from your organization to the training? (up to 4 per organization) *

Maybe

Yes, 1

Yes, 2

Yes, 3

Required

What meeting times in/near JULY 2021 would you prefer? (Check as many as possible). Note: you may 'alternate' dates with work colleagues if necessary. All times are in EST. *

3-5pm, twice a week

1-5pm (with breaks), once a week

6-8pm, twice a week

5-9pm (with breaks), once a week

Saturdays, 9-1pm (with breaks)

Combination of weekday/weekend hours

Other:

Required

If necessary, would you be available...

Last week of June

First week of August

Other

If some hybrid meetings are possible, would you be interested in coming to the Tufts campus in Medford? *

Probably

Maybe

Definitely not

Other:

How likely are you to enroll in this course? *

Unlikely

Very likely

Is there anything else you would like us to know as we plan this course?

A copy of your responses will be emailed to the address you provided.

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