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Focus Group Sign-up for CHA

Sign-up for CHA Focus Group

Ashland County is conducting Focus Groups for gathering information for the upcoming Community Health Assessment. These are demographic questions to help select those who would be eligible to participate. Only citizens over the 18 are eligible to be considered. Applying does not guarantee selection. Gift cards of $50.00 will be provided to those who successfully attend/participate in the scheduled focus groups. 

We thank you for your interest in being a part of this community process. 
This question requires a valid email address.
5. Are you: *This question is required.
6. Age: (Must be over 18 to be considered for the focus group) *This question is required.
7. How would you best describe yourself *This question is required.
8. Are you of Hispanic/Latino/Spanish origin *This question is required.
9. What is your annual family income *This question is required.
10. What is your employment status? *This question is required.
11. Other than yourself, how many others live in your household *This question is required.
12. Are you married *This question is required.
13. What is your educational background *This question is required.
14. Do you have a primary care doctor *This question is required.
15. Do you have children in K-12 grade *This question is required.
16. Which of the following times would work best for you if you were selected to participate: *This question is required.
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