Consent Form

3. Consent form_020917.docx

Focus Group Testing to Effectively Plan and Tailor Cancer Prevention and Control Communication Campaigns

Consent Form

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Consent Form



Who is sponsoring this group discussion? The Centers for Disease Control and Prevention (CDC).

What is the purpose of this group discussion? The purpose of this discussion is to gather information about REACH awardees’ satisfaction with the technical assistance (TA) provided by CDC contractors, including information about the aspects of TA awardees find most useful, any challenges awardees have experienced obtaining TA, and recommendations for improving the TA offered to awardees.

What does participation involve? If you choose to take part in this discussion, you will take part in a call with up to two other members of your REACH program team. Program managers, evaluation leads, and communication leads have been invited to participate in group discussions.

How was my name selected? You were selected to participate in this discussion because your REACH program was identified as a “high user” of TA services provided by TACTIC providers, evaluation liaisons, and/or communication liaisons.

With whom will my group discussion comments be shared? Although the discussion will be audio-recorded, your name will not be included on any of the notes or summary reports that we provide to CDC.

Will I be compensated for my participation? Participation in the group discussion is voluntary, no compensation will be provided. CDC will share findings with participants upon request.

Who can I contact if I have questions? If you have any questions, you may contact Tim LaPier at [email protected] or (770) 488-5772.

Please keep one copy of this consent form for your records. If you agree to participate in the discussion, please sign below.



Printed Name ________________________



Signature ________________________



Date ________________________







File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKeating, Michael
File Modified0000-00-00
File Created2021-01-22

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