Careers of Public Health Focus Group
Thank you for your interest in participating in our focus group. Please take a few moments to complete this registration form. The focus group will be held remotely on Zoom on Tuesday, October 3rd from 12:00 - 1:00pm. 

Your responses are confidential and will NOT be shared with the MA Department of Public Health, Office of Local and Regional Health. Your responses will only be viewed by Human In Common (diversity consultants) and Redfin Solutions (website developers) for the purpose of conducting this focus group and creating an inclusive local public health website. All responses will be deleted upon completion of the project. You will receive a confirmation of your registration in the focus group and further details in the coming weeks. 
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Email *
First name *
Last name *
Cell phone number *
Name you would like us to use when addressing you *
Personal pronoun *
Workplace (if you are currently employed)
Position (if you are currently employed)
Length of time in current job position (if you are currently employed)
School (if you are a student)
Major and/or certification program (if you are a student)
Expected year of graduation
Have you searched for a new job in the past 12 months?
Clear selection
Do you anticipate searching for a new job in the next two years?
Clear selection
My gender (check all that apply) *
Required
My racial/ethnic identities (check all that apply)
 *
Required
I describe my sexual orientation as (please check all that apply)
 *
Required
I describe my religious/spiritual affiliation as (please check all that apply)
 *
Required
Are you a military veteran?
Clear selection
Please list any disability accommodations you would like to request in order to participate in the focus group. 
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