California Focus Group Opportunity

All Children Are Born Healthy

We want to learn from people of color who live in low income households and are either pregnant or parents of young children to help inform a new 10-year child and family initiative philanthropic initiative.

The Focus Group will be held for 90 minutes on Zoom, either in the late afternoon on Saturday, December 17 or Sunday, December 18.
If you're selected to participate in a focus group, we will contact you by email and cell to let you know the exact date and time of your group.

You will receive $175 to thank you for sharing your experience with us. Only focus group participants will receive payment.

If you have questions now, email LaToshia Rouse or Kate Robinson.

Question Title

* 1. Please provide the following information.

First & Last Name

Cell Phone Number with area code (this is how we will let you know you are invited to a focus group)

Question Title

* 2. Where do you live?

Southern California / Inland Empire

Santa Clara County

Monterey County or Central Valley Counties

Other (please specify)

Question Title

* 3. Tell us about the area where you live.

Urban

Suburb

Rural

Frontier

Question Title

* 4. Please let us know the following (check all that apply).

I am currently pregnant

I am the mother of a child younger than 3 years old

I am the father of a child younger than 3 years old

I am a caregiver of a child younger than 3 years old

My child or the child I care for has a special health care need or disability

Other (please specify)

Question Title

* 5. What type of health insurance do you have (check all that apply)?

Employer-sponsored insurance

MEDI-CAL

Tricare (the health care program of the U.S. military system)

No insurance at this time

Other (please specify)

Question Title

* 6. What type of health insurance does your child younger than age 3 have (check all that apply)?

Employer-sponsored insurance

MEDI-CAL

MEDI-CAL Waiver for a child with a disability

Tricare (the health care program of the U.S. military system)

No insurance at this time

Other (please specify)

Question Title

* 7. How do you identify by race and ethnicity (check all that apply). Note: you do not have to answer this question, but race and ethnicity are selection criteria for the focus groups.

African American or Black, non-Hispanic

African American or Black, Hispanic

American Indian/Alaska Native, non-Hispanic

Asian, non-Hispanic

Multiple race, non-Hispanic

Native Hawaiian/Other Pacific Islander, non-Hispanic

White, non-Hispanic

White, Hispanic

Two or more races, non-Hispanic

Two or more races, Hispanic

Prefer not to answer

Other (please specify)

Question Title

* 8. Let us know your preferred language

English

Spanish

Other (please specify)

Question Title

* 9. If you are not selected to participate in the focus group, may Family Voices National keep your information on file and contact you again about other family engagement opportunities?

Yes

THANK YOU!