Online Forms

Community Safety Initiative Focus Group signup form

2. INTEREST TO ATTEND A FOCUS GROUP SESSION ON COMMUNITY SAFETY
   These focus group sessions are being scheduled for the City of Eugene to listen to Black, Indigenous, and other people of color regarding community safety. Please use this form to confirm your interest and availability to attend a focus group regarding potential changes to the Community Safety Initiative.

   These focus group sessions are being scheduled for the City of Eugene to listen to Black, Indigenous, and other people of color regarding community safety. Please use this form to confirm your interest and availability to attend a focus group regarding potential changes to the Community Safety Initiative.

4. First Name*

5. Last Name*

7. Address Contact*

9. City*

10. State Name*

11. ZIP*

13. Email*

14. Phone*

15. Extension

17. Your racial and ethnic identity*

    Check all options that apply to how you describe yourself

    1. Black, African, or African American
    2. Asian, Southeast Asian
    3. Hawaiian, Pacific Islander
    4. Hispanic or Latino (Mexico, Central and South America)
    5. Native American or Indigenous
    6. White or Caucasian
    7. Multiracial or Mixed
    8. Middle-Easterner or Arab
    9. Another
19. Are you affiliated with any organization(s) representing or serving Black, Indigenous, and other people of color?

    Please indicate your affiliations with any nonprofits, religious organizations, schools or universities, government agencies, etc.

21. Indicate your availability to attend a focus group session

    Check all that apply. HRNI staff will coordinate your registration for one of the focus group sessions via e-mail or phone.

    1. Dec/8, Tuesday, 4-6pm
    2. Dec/11, Friday, 12-2pm
23. Other ways to participate
    If the dates above do not work you, you can participate in this discussion by attending a public meeting (dates TBD), answering a survey, and submitting questions or reading available answers at a Q&A page. See details at www.eugene-or.gov/CSIengagement

    If the dates above do not work you, you can participate in this discussion by attending a public meeting (dates TBD), answering a survey, and submitting questions or reading available answers at a Q&A page. See details at www.eugene-or.gov/CSIengagement

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field