Older Adults & Substance Use Disorder Focus Group Application
Oregon Recovers and AGE+ are conducting a study of SUD treatment services and supportive housing resources for older Oregonians. We are seeking applicants who are residents of Oregon, age 60 or above, to participate in a series of in-person and virtual focus groups around the state during the month of August. All information provided will remain strictly confidential. There are limited spaces available, but those who are selected will receive a $50 gift card for participation. Application deadline is Friday, August 5th.
Name (last name optional)
First Name
Last Name
E-mail
example@example.com
Phone Number
Please enter a valid phone number.
What city do you live in?
What is your age?
Are you in recovery?
Yes
No
If so, for how long?
Did you attend formal treatment?
Yes
No
Do you currently, or have you ever lived in recovery housing?
Yes
No
Do you have a close family member in recovery?
Parent
Child
Sibling
Partner/Spouse
Other
What is their age?
How long have they been in recovery?
To which sexual orientation do you most identify with?
Heterosexual
Gay/Lesbian
Bisexual/Pansexual
Asexual
Prefer not to say
Other
To which gender do you most identify?
Female
Male
Non-Binary
Genderqueer
Prefer Not to Say
Other
What is your race/ethnicity? (check all that apply)
American Indian or Alaska Native
Asian or Asian American
Black or African American
Hispanic or Latinx
Native Hawaiian or Other Pacific Islander
Middle Eastern, North African or Arab American
White or European American
Prefer not to say
Other
Would you be more comfortable in a LGBTQ+ or BIPOC specific group, or would you prefer an integrated group?
Which time of day is best for you to participate in a focus group?
Morning
Afternoon
Evening
What about your recovery experience would you like us to know?
Please verify that you are human
*
Submit
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