Fred Hutch Focus Group

Focus Group Interest Form

A project of Team Survivor Northwest and Fred Hutch Cancer Center
Team Survivor Northwest is conducting a focus group for 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.

A focus group is a discussion panel where a moderator will ask the group for opinions and comments. You must be willing to speak in a group setting involving up to 10 other women in order to participate. Participants will be compensated $25 for a one-hour commitment. If we meet in person, there will also be food for you to enjoy during your focus group.

The following information will be kept confidential and will be used to contact you for potential focus group participation.
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 this focus group:
Where would be you most comfortable meeting (Check all that apply)?

In person at an indoor location in Columbia City In person outdoors in Columbia City (ex: a covered park shelter) On Zoom

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

Would you need (Check all that apply):

Childcare Interpreter (see below)
What language?
What ethnicity do you most identify with? *

American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Other (please identify in box below)
Ethnicity
Please indicate your age group: *

18-29 30-39 40-49 50-59 60-69 70+
Is there anything else you would like us to know?
Should be Empty:

Focus Group Interest Form