Focus Group Demographic Survey

OMB Control Number: 0970-0519
Expiration Date: 10/31/2021

FOCUS GROUP
DEMOGRAPHIC

Survey

Background
Please complete the following information to describe your demographics.
•
•
•

All of the information you share with us today will be kept CONFIDENTIAL. What you say will not be
identified with your name.
This form is OPTIONAL and will only be used to help describe the types of people who participated in
this focus group to help inform National Human Trafficking Training and Technical Assistance Center's
(NHTTAC) training and technical assistance services.
If you have any questions about this focus group or the project, please contact [insert].

1. Which of the following best describes the organization in which you work? (Mark all that apply.)
Academic institution
Anti-trafficking organization
Business/For-profit organization
Coalition/Multidisciplinary team/Task
force
Federal government
Faith-based organization
State and local government
Nonprofit/Community-based
organization

OTIP grantee
Self-employed
Survivor-led organization
Tribal government
Union/Worker advocacy organization
Victim service provider
Other (please specify):
_____________________

2. Is your organization responsible for working with people who are currently being trafficked or have been
trafficked? □

Yes □ No

3. Which of the following best describes your professional capacity or types of services you provide? (Mark
all that apply.)
Behavioral health professional (e.g.,
psychologist, psychiatrist, mental
health/substance use counselor)
Child welfare (e.g., state agency staff,
child welfare contractor, nonprofit
personnel)
Corrections-based services (e.g., parole,
probation)
Criminal justice (e.g., law enforcement,
prosecutor, probation, court, forensic
interviewer)
Educator (e.g., teacher, professor, school
administrator)
Health care (e.g., physician, physician
assistant, nurse practitioner, dentist,
nurse, pharmacist)

Housing (e.g., case worker, shelter
director, public housing authority
agencies)
Legal (e.g., immigration, civil and/or
rights-based attorney and/or paralegal,
clinic)
Public health (e.g., licensure board,
health department staff, health care
executive, community health workers)
Social worker (e.g., case manager,
school counselor, supervisor,
administrator)
Survivor empowerment, mentoring, or
peer to peer
Violence prevention (e.g., child abuse
and neglect, elder abuse, domestic
violence, sexual violence, youth
violence)

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB
control number. The estimated average time to complete this form is 2 minutes. If you have comments regarding the accuracy of this
estimate or additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway,
Fairfax, VA 22031.

OMB Control Number: 0970-0519
Expiration Date: 10/31/2021

FOCUS GROUP
DEMOGRAPHIC

Survey

Other (please specify):
_______________________________

4. In your professional capacity, how frequently do you come into contact with a person who is currently being
trafficked, at risk of being trafficked, or has been trafficked?
1

2

3

4

Never

Occasionally

Frequently

Daily

5. Which of the following best describes the number of years of experience you have in your current field of work?
□

Less than 3 years

□

3–5 years

□

□

6–10 years

More than 10 years

6. Which of the following best describes your primary role in your current position?
□
□
□

Direct delivery/Frontline staff
□ Consultant/Trainer
Management
□ Volunteer
Other (please specify): _______________

□
□

Administration
Peer educator

7. Which of the following best describes your geographic population? (Mark all that apply.)
□

□
□
□

National
State (please specify): ______________
Tribal
International (please specify country):
_________________________________

□
□
□

□

Local

Urban
Rural
Suburban

8. Please select any of the following populations you currently work with in a professional capacity. (Mark all that
apply.)
Human trafficking
Commercial sexual exploitation of
children
Sex trafficking
Adults
Minors
Labor trafficking
Adults
Minors
Children/youth
Out of home/Foster care/Kinship care
Juvenile justice
Runaway/Homeless youth
People with disabilities

Deaf/Hearing impaired
Elderly
Lesbian, gay, bisexual, transgender, and
questioning
Foreign nationals (migrant workers,
undocumented immigrants, refugees)
People with low incomes
Racial and ethnic minorities
American Indian or Alaska Native
Asian
Black or African American
Native Hawaii or other Pacific Islander
White
Hispanic or Latino ethnicity

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid
OMB control number. The estimated average time to complete this form is 2 minutes. If you have comments regarding the
accuracy of this estimate or additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or
9300 Lee Highway, Fairfax, VA 22031.

FOCUS GROUP
DEMOGRAPHIC

OMB Control Number: 0970-0519
Expiration Date: 10/31/2021

Survey

History of substance use
Intimate partner violence (e.g., dating,
domestic violence)

Gang-related crime
Sexual abuse/Violence
Other (please specify): __________________

9. What is your race? (Mark all that apply.)







American Indian or Alaska Native
Asian
Black or African American
Native Hawaii or other Pacific Islander
White
Other (please specify): _______________________________________

10. What is your ethnicity? (Mark all that apply.)
 Hispanic or Latino
 Middle Eastern or North African
 Other (please specify): ________________________________________

11. What is your gender? (Mark all that apply.)





Male
Female
Transgender
Other (please specify): ________________________________________

Thank you for taking the time to complete this form and helping to improve NHTTAC/SOAR activities.

Paperwork Reduction Act Notice
Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The estimated average time to complete this form is 2 minutes. If you have comments regarding the accuracy of this estimate or
additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.