Focus Group Pre-Registration

(Disponible en español)

Thank you for your interest in participating in a community focus group in your county. Your experience receiving services in the medical, dental, behavioral health, food, housing, transportation, and childcare sectors in your county will help shape future programs and services.

This screening and registration form should take about 3 minutes to complete. If you qualify to participate in this community focus group, we will contact you to confirm your participation and provide additional details.

Are you 18 years or older? *

Which New Mexico county do you live in? *Select from the listed counties or choose "not listed"

Have you received housing, public transportation, food, medical care, dental care, mental or behavioral healthcare, or childcare services in your county? *

Are you available to participate in a focus group in Chaves County at Eastern New Mexico University – Roswell, Instructional Technology Center – Computer Commons on Dec 3rd from 10am to 12pm with check-in at 9:30? *

Are you available to participate in a focus group in Doña Ana County on Dec 4th from 10am to 12pm at the Dr. Karen A. Trujillo Administration Complex – Las Cruces Public Schools – Conference Rooms A & B, 505 S. Main St., Suite 249 Las Cruces? *

Are you available to participate in a focus group in McKinley County on TBD from ___ to ___? *

Are you available to participate in a focus group at the Red Willow Education Center in Taos Pueblo on Oct 29th from 10am to 12pm and be able to check-in at 9:30am? *

Are you available to participate in a focus group in Valencia County on Jan 7th and 8th from ___ to ___? *

Thank you for your interest.

Thank you for taking the time to inquire about focus group eligibility. We are only taking applications for focus group participation from residents who are 18 years or older. We may have opportunities for you to participate in the future, so please make sure you are on our mailing list to receive notifications.

Thank you for your interest.

Thank you for taking the time to inquire about focus group eligibility. We are only taking applications for focus group participation from residents in the listed counties. We may add more locations in the future, so please make sure you are on our mailing list to receive notification.

Thank you for your interest.

Thank you for taking the time to inquire about focus group eligibility. We are only taking applications from individuals who have accessed one or more of the listed services in the participating counties. We may update this information in the future, so please make sure you are on our mailing list to receive notification.

Thank you for your interest.

Thank you for taking the time to inquire about focus group eligibility. We only have the listed dates available for focus groups at this time. We may add more counties and focus groups in the future, so please make sure you are on our mailing list to receive notification.

Personal InformationThank you for confirming your focus group eligibility. Please complete all required fields below. We will contact you with further information and a confirmation of acceptance.

First Name *

Last Name *

Your Email Address (enter "none" if you do not have email) *By contacting us, you are giving us permission to contact you back via email and send you updates in the future. You may opt out at any time.

Phone/Message number with area code *

Which is your preferred contact method? *

Are you engaged with a 100% New Mexico initiative in your county? *Please let us know if you are already working with 100% New Mexico in your county

What language(s) do you speak? *

Do you need interpretation services to participate in the focus group? *

Please enter the interpretation language that you will need. *

Demographic Information

The following demographic information will be used only for describing the general makeup of the focus group. It will not be used to determine individual eligibility.

Your Race *Please describe your race or enter "Prefer not to say"

Your Ethnicity *Please describe your ethnicity or enter "Prefer not to say"

Recording the Event

Please note that we will be recording this event for evaluation purposes. Please agree to our release statement (opens in new tab). I acknowledge that I agree to the linked release.

Recording release decision *

We're sorry

Thank you for your interest. Unfortunately, you are not eligible to participate. Independent evaluators need the ability to review a recording of this event. You can change your response to "I agree" and continue with the application or simply close your browser tab.