Focus Group Information

Thank you for expressing an interest in the JJH Focus Group. Please complete the application below.

Question Title

* 1. Name

Question Title

* 2. Contact Information

Name

Address

Address 2

City/Town

County

Post Code

Email Address

Phone Number

Question Title

* 3. Preferred method of communication?

Email

Phone

Post

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* 4. Do you use social media?

	Facebook	Twitter	Linked In	Instagram
Yes	Yes Facebook	Yes Twitter	Yes Linked In	Yes Instagram
No	No Facebook	No Twitter	No Linked In	No Instagram

Question Title

* 5. What are your main areas of interest and experience that you could help us with?

Housing

Finance

Welfare advice

Technology

Fundraising

Social activities / Social groups

Digital inclusion / Digital Champion

Telecare

Other (please specify)

Question Title

* 6. Can we keep your details for future resident involvement communication

Yes

No