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If you live in one of the Philadelphia neighborhoods of Bridesburg, Frankford, Port Richmond, or Wissinoming and are interested in participating in one of our focus groups in mid-September on neighborhood issues, please fill out the information below. Participants will receive $100 upon completion of their group.

This information is for research and screening purposes only and will be kept confidential. It will not be shared, and you will not receive marketing offers as a result of completing this questionnaire.

If you have any problems using this form, please contact

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If Spanish is your primary language:
Si desea responder las siguientes preguntas en español, por favor oprima aquí.

1. Please provide your contact information so we know how to get in touch with you. *This question is required.
2. 1. What neighborhood do you live in? *This question is required.
3. 2. What is your age? *This question is required.
4. 3. What is your gender? *This question is required.
5. 4. Do you identify your race or ethnicity as...? *This question is required.
This question requires a valid number format.
7. 6. Have you visited any of these parks? *This question is required.