Intake Form - Research Study: One-on-One Phone Interview

Maternal Minds is seeking volunteers to participate in a one-on-one research 30-minute interview and complete a community survey. Participants will offer valuable feedback on the challenges faced by Muslim mothers in our community.

Researcher: Sehrish Malik, Maternal Minds Program Director

Title: Sustaining Maternal Empowerment

Location: Phone appointment led by Facilitator

Your insights will help us identify key areas to focus on in our future programs.

To learn more about our work with the Muslim community, please visit maternalminds.org or follow us on Instagram at @maternal.minds.

Thank you for your willingness to share your experiences and help shape our programs!

Please note that a $15 honorarium will be provided as a token of appreciation for your time and contributions.

Unfortunately, Focus Group participants are not eligible to participate in the one-on-one interview.

Only selected participants will be contacted.

Name*

First NameLast Name

Email*

example@example.com

Where can we send you an e-transfer?*

example@example.com

Please indicate a phone number for the virtual interview:*

Please enter a valid phone number.

Do you identify as a Muslim mother?*

YesNo

Unfortunately, you do not qualify for the one-on-one interview.

Do you reside in the Halton region?*

YesNo

Unfortunately, you do not qualify for the one-on-one interview.

Would you like to be added to our email list and WhatsApp Community to learn about our future programs and upcoming opportunities?*

YesNo

Where did you hear about this research study?*

Please note that only selected participants will be contacted for an intake call to schedule a one-on-one interview.