Brandeis Vaping Focus Group

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Please fill out the form below to sign up for a vaping focus group. Brandeis students who vape nicotine liquids/JUUL, and/or THC liquids, concentrates, or bud, are all welcome.

This form is CONFIDENTIAL, and will only be seen by Leah Berkenwald, Director of Health Promotion and Wellness Initiatives, for the purposes of scheduling vaping focus groups. After the focus groups are completed, this survey and all records related to this form will be deleted.

Name *

Brandeis Email *

Class Year

First Year (Fall admit)

First Year (January admit)

Second Year

Third Year

Fourth Year

Graduate Student

Clear selection

Age *

17 or younger

18-20

21-22

23-24

25 or older

Gender Identity *

Female

Male

Transgender

Non-binary

Prefer not to say

Other:

How often do you vape?

Never

Once a semester or less

Once a month or less

Several times a month

Several times a week

Several times a day

Several times in an hour

Clear selection

Please indicate your availability to participate in a focus group. (Check all that apply)

Morning (10am-12pm)

Lunch (12-2pm)

Afternoon (2-4pm)

Evening (5-7pm)

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Submit

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