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Heat at Home: SGV Community Workshop Interest Form

Your experience can help shape what comes next for housing and extreme heat in the SGV. I’m inviting 5–10 community members to join a paid, 2-hour Zoom workshop and share their perspectives.

If you’re interested, please fill out this short form by Sunday, October 25. Everyone who fills out this form will hear back by Wednesday, October 28, whether or not they are selected. Selected participants will receive a $100 honorarium.

When: Saturday, November 7
Time: 1:00–3:00 PM Pacific Time
Location: Zoom
Honorarium: $100 Venmo/Zelle
Capacity: 5–10 participants

Your full name

Your email

Can you attend the full Zoom workshop on Saturday, November 7, from 1:00–3:00 PM Pacific Time?

A
B
C
D

Consent To Zoom Recording
I understand that the workshop will be audio and video recorded and that recording is required to participate. I understand that turning on my camera is optional.

A
B
You will receive a separate consent form with full information about recording and privacy before you decide whether to participate.

Are there factors that make extreme heat especially difficult or risky for you or someone you care for? Select all that apply.

How do you describe your race and/or ethnicity? Select all that apply.

Is there anything else you would like me to know about your racial, ethnic, cultural, or Indigenous identity?

What kind of home do you currently live in?

How long have you lived in the San Gabriel Valley?

Is there anything about your experience with housing or extreme heat that you think would be useful for this workshop?

Please share only what you are comfortable sharing. You do not need to tell me medical details or other private information.

Do you need any accommodations to participate in a two-hour Zoom workshop?

A
B
C

Phone number

How did you hear about this workshop?

Will I Be Paid?
Yes. You will receive a $100 honorarium for participating in the workshop. The workshop has a fixed participant-compensation budget. If fewer than 10 people participate, I may increase the honorarium equally for everyone who participates, up to $200 per person. Any amount above $100 is not guaranteed. You will still receive your honorarium if you need to leave the workshop early. After the workshop, I will send you a short payment form asking for the Venmo or Zelle information needed to send your honorarium. Your payment information will be used only to send compensation and will not be analyzed as research data. After the workshop, payment information such as a Venmo username, phone number, or email used for Zelle will be collected separately from workshop research data. It will be used only to send the honorarium and will not be included in research analysis.
Do I Have To Stay For The Whole Workshop?
The workshop is scheduled for Saturday, November 7, from 1:00–3:00 PM Pacific Time, and I hope participants can attend for the full session. If you need to leave early, please notify me in advance. You will still receive the $100 honorarium. You may also skip any question or activity, take a break, or stop participating at any time.
Can My Participation Be Completely Private?
No. This is a group workshop. I will protect your information in my research records and remove names and identifying details from research products when possible. Other workshop participants will hear what you say and may see you if you choose to turn on your camera. I will ask everyone to respect one another's privacy and not repeat personal information outside the workshop. I cannot guarantee that another participant will follow that request. Please share only information you are comfortable discussing in a group.