Older Adults & SUD Focus Group Application

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 *
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Older Adults & Substance Use Disorder Focus Group Application