ROCIS Cohort 48 Registration Online Cohort Question Title * 1. Contact info: Name * Affiliation (if applicable) Email Address * Phone Number (Landline) * Question Title * 2. Preferred contact method? Landline Cell E-mail Question Title * 3. Best time to contact? Question Title * 4. Other household members who will be participating? Name Email Address (if appropriate) Question Title * 5. Where are you interested in monitoring? Home Workplace Both Question Title * 6. In which municipality or neighborhood(s) do you plan to monitor? Question Title * 7. Monitoring Address(es): Site #1 STREET: Site #1 MUNICIPALITY: Site #1 ZIP: Site #2 STREET: Site #2 MUNICIPALITY: Site #2 ZIP: Question Title * 8. Have you reviewed the LCMP Expectations? Yes No Question Title * 9. The Cohort starts Thursday, July 8 and ends Friday, August 6.The 75-minute kick-off meeting is mandatory and will convene online. There are two identical sessions July 8 from 7-8:15 PM & July 9 from 10:30 AM-11:45 AM. Do you have availability and interest to participate in the upcoming Cohort and the 4 required online meetings (Kick-off, Dylos Downloading, Filtration Interventions, and Wrap-up). Yes Maybe No Comments Question Title * 10. There are 6 additional 75-minute online meetings. Each one is repeated to accommodate your schedule. To gain the full value of participating, attendance at all meetings is highly recommended.Do you have availability and interest to participate in the most of the additional 6 optional online meetings? Yes Maybe No Comments Question Title * 11. Is it OK to send you a text to contact you as we are arranging the monitoring kit drop-off or pick-up? Yes No Cell phone number: Question Title * 12. Is it OK to send you a text to provide a reminder, or confirm that we have received information from you? Yes No Cell phone number: Question Title * 13. Preferred availability for early-week virtual meetings: Monday PM Tuesday AM No preference Question Title * 14. Preferred availability for late-week virtual meetings: Thursday PM Friday AM No preference Question Title * 15. One of the air quality monitors requires a protected, outdoor location (covered porch, picnic table with a weather-proof covering, etc.) with access to a power source. I have confirmed I have a suitable outdoor location with access to power. Yes No Please specify where you plan to place the monitor: Question Title * 16. Do you have reliable access to internet? Yes No Question Title * 17. What computer operating system do you have? Windows Mac Not sure Question Title * 18. What do you hope to gain from participating? Question Title * 19. Summarize how you will be able to apply the knowledge/experience gained through participation in the upcoming LCMP cohort: Question Title * 20. How did you hear about the ROCIS Low Cost Monitoring Project? Question Title * 21. Keep me informed of opportunities to participate in the future. Yes No Question Title * 22. Add my name to the ROCIS e-mail contact list: Yes No Already on your email contact list Question Title * 23. Any comments or questions? Done
