Fred Hutch Interviews

Informational Interview Interest Form

A project of Team Survivor Northwest and Fred Hutch Cancer Center
Team Survivor Northwest is conducting informational interviews with women of color in Columbia City who have had a cancer diagnosis at any point in their lives. We want your input on what types of free exercise programs we can offer that will meet your needs and improve your health.

The interviews will take place virtually and will include an interviewer asking you for your opinions and comments. Participants will be compensated $25 for a one-hour commitment.

The following information will be kept confidential and will be used to contact you for a potential interview.
Name*

First Name Last Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Zip Code*
Please enter your zip code
If you are chosen for the interview:

What days and times work best for you to participate (Check all that apply)?*

Would you need an interpreter?

YesNo
If you answered yes above, what language?
What ethnicity do you most identify with?*

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhiteOther (please identify in box below)
Ethnicity
Please indicate your age group:*

18-2930-3940-4950-5960-6970+
Is there anything else you would like us to know?
Should be Empty:

Informational Interview Interest Form