Cultural Agility Research Registration Form

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To Participate in this research you we need to know what time you will be attending the focus group. We will also need to know where to ship art supplies that we will be using to supplement this research activity. Please note that you can withdraw from this research at any time.
Once you have filled out the form we will follow up with some forms that you will need to fill out.
If you have any questions about this form please call:
Marion Erickson, (Dakelh Nation) at 250-640-3927

Email *

First and Last Name *

Occupation *

phone number (we will need this to phone quickly to pre-screen you to ensure you fit the description of our target demographic) *

Home Address (Please note that we are specifically interested in interviewing those who work in the Northern Health Area) *

Apartment Number *

City, town, community *

Postal Code *

P0 BOX Number

Delivery Instructions (in-case of special delivery instructions for delivery person) *

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