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Tell us about yourself
(Next Step is: 6 minute Benefit Screener)

Could you provide proof of Colorado residency?*

Demographics

We collect demographic information to ensure that our CDIG community reflects the diversity of the communities we serve.

Which of the following best describes your gender identity? *
What do you identify as?*
Select all that apply.

Financial Eligibility

What is your annual household income?*
What is your employment status?*
What type of Assistance Programs have you used? Select all that apply*

Areas of Interest for Feedback


Please select all that apply.

Mother and Child Health:
Birth to Age 5:
K-12 Education:
Family Economic Mobility:

Legal and Consent

Colorado Design Insight Group at Gary Community Ventures ("Gary") Consent Form

By providing your information on the signup for you may be invited to take part in an interview(s)and/or usability test(s). Please read this form carefully, or have someone read it to you, and ask any  questions you may have before agreeing to take part in this interview(s). If the consent form is being  read to you, either in English or another language, please also have a witness who was present for  the reading sign below. 

What is this about: The purpose of this research is to gather insights about the lives of residents of Denver, Colorado and surrounding counties. We aim to use what we learn for three key purposes: to inform the creation of new digital products that Gary will be developing and building; to inform Gary in its development and support of programs that advance Gary's charitable mission; and to share these valuable insights with our affiliates, so they too can learn from the community and enhance their programs and initiatives. Through this collaborative approach, we seek to make a broader, more meaningful impact on the community we service.  

Notes and recordings: We will take notes and make an audio and/or video recording of your interview/usability test. These will be used for review and analysis purposes. We may share  notes or recordings made with additional organizations that partner with Gary programs. Your name, address and other  personally-identifying information will not appear in any transcriptions of an interview/usability  test. The results of this research may be published. Any excerpted information or quotations that  are used in presentations or publications will be made anonymous. Still, if you wish, you may  choose to participate without being audio or video recorded, in which case we will only take notes. 

Payment: You will receive $30 per hour for your participation in each interview/usability test. We reserve the right to increase this amount if necessary.

Taking part is voluntary: Taking part in an interview or usability test with Gary is completely voluntary. You do not have to answer any questions that you do not feel  comfortable answering. You may instruct the interviewer to stop the interview at any time, in which  case no subsequent actions performed by you will be included in our records. You may also instruct  Gary to destroy all records of your participation at any time.  

Questions: If you have any questions, concerns or complaints about this research, please contact cdig@garycommunity.org.

By typing in your name and clicking on "Submit", you are electronically signing this document.