Focus group (2005).

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Focus group volunteer form

We welcome focus group participants from all divisions and departments of the medical campus.  For each session, we try to assemble a group that brings a diversity of perspectives.  So it helps us to know a little about you and your interests, in addition to your willingness to participate.

If you'd like to learn more about the focus group process, including the potential risks and benefits to you, that information is available here.  

1. Your contact information

Your name:
  

Your email address:                                               Your telephone number:
   

Your departmental or organizational affiliation:
  

Your job title or work classification:
  

2. Your information technology use and interests

For what types of work do you regularly use a personal computer or shared information system?  (Please check all that apply.)

    Administration or business functions
    Clinical care
    Research
    Education or training
    Other, please specify: 
           

Are there particular information technology issues in which you have an interest?

3. Days you are available

What day(s) of the week would generally be best for you -- for a noon to 1:30pm focus group session on the Medical campus?  (Please check all that apply.)

     Monday
     Tuesday
     Wednesday
     Thursday
     Friday

All sessions will be held in the Mailman Center for Child Development, in room 3003 (third floor). 

We appreciate your willingness to help us improve information technology services.  If your interests match our discussion topics, a member of our staff will contact you to confirm your willingness and ability to attend a session on a particular date.