Water Reuse Focus Group Screener

Water Reuse Focus Group Screener

Thank you for your interest in our virtual, 90-minute Water Reuse focus groups. The short form below will help us understand if you qualify to participate.

Focus group participants will receive a small incentive for participation.

Please note that completing this form does not obligate you to participate in the project, nor does it guarantee a spot in our focus group discussion. The information you provide will only be shared with research project staff at Iowa State University.

1. Full Name*

2. Please select your current age range.*

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3. Please select your current state of residence.*

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4. Which of the following best describes the area where you live?*

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5. Are you one of the primary income-earners for your household?*

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6. Currently, are you at least partially responsible for paying water bills in your household?*

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7. How much do you pay per month on average for water?*

Please provide an estimate.

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8. What was your total household income before tax during the past 12 months?

Your household income is the total yearly pre-tax income for all members of your household ages 18 and older.

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YOU MAY BE ELIGIBLE TO PARTICIPATE!

Please provide the following contact information so that we may reach you if you are selected for the study.

Please note that we will only contact you about this project. We will never share your name or contact information with third parties and your contact information will be deleted after this project ends.

Email Address*

Please enter an email address that you check regularly.

Phone Number*

Please enter a valid phone number where you can be reached with updates on the day of our discussion.

NOTE: Due to fraudulent activity, only applicants with valid phone numbers will be considered. Fake or unregistered phone numbers will disqualify applicants from participation.

Phone

Is it okay to contact you about this project via text message?

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Zip Code*

Are you willing to participate in a virtual 90-minute focus group session on Zoom sometime next month (September 2023)?*

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When are you most likely to be available to participate in a 90-minute focus group?*

Please select all that apply. Selecting multiple options will increase your chances of being selected to participate.

Monday, September 11th from 2:30 - 4:00 pm CST

Tuesday, September 12th from 3:00 - 4:30 pm CST

Wednesday, September 13th from 5:30 - 7:00 pm CST

Thursday, September 14th from 6:30 - 8:00 pm CST

Saturday, September 16th from 10:30 am - 12:00 pm CST

Saturday, September 16th from 2:30 - 4:00 pm CST

I am not available to participate on any of the dates above.

CONSENT FOR PARTICIPATION IN RESEARCH

By checking the box below, I acknowledge the following:

I agree to be contacted about participating in a 90-minute online focus group conducted by Iowa State University.

I can change my mind about participation at any time and I can skip any questions that I do not wish to answer.

This focus group will be recorded and transcribed, but my identity will remain confidential.

I must respect the privacy of other participants during this discussion.

To review and download the entire research consent form, please click here.

I agree to be contacted about participation in this project.*

In what color is the text printed below?

This is a security question used only to prevent bots from filling out our form.

QUESTIONS?

Contact project manager Ellen McIntosh at emmalven@iastate.edu.

Learn more about our organization:

www.cssm.iastate.edu/survey-research-services-srs

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