Participant Interest Form
Please answer the following questions if you are interested in participating in a community engagement project at FOOD For Lane County. 

This is a great way to provide feedback for FFLC partners, whether anonymously or not. 

Our community engagement programs include: Participant Observation Program (POP), Participant Advisory Councils (PAC), listening sessions.

If you have any other questions, please email the Community Engagement Coordinator.
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Which program(s) are you interested in joining to provide feedback? *
Required
Is there a specific FFLC partner you would like to provide feedback about? Please name the partner(s) here.

We will be facilitating these programs at different partners over time.
 *
Would you like to be contacted about being involved and providing feedback through any of these programs?

Please provide the best way to contact you. This might be email or phone number, or both. If there is a specific time that is best to reach you, please include that.
 *
Where do you live? / Where do you go to get food?
What languages do you feel comfortable speaking?
Would you like to self-identify? 

This question is optional. You can choose to answer if you feel you are bringing a particular lens to offer feedback.

If these options don't apply for you, or you want to add something more specific, please check "Other" and fill it in.
Will you need compensation for childcare in order to participate in this program?
Clear selection
Are you willing and able to be responsible for your own actions and agree not to hold FFLC responsible for any damages you cause or experience?
Clear selection
Do you have any other comments you want to share?
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