Wellbeing Study Interest Form
Please fill out the form below to share a bit about you and your professional role and to indicate your interest in participating in a focus group and/or interview as part of a VCU study on the facilitators and barriers of wellbeing for early childhood professionals. 
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Your name (first & last)
Your email address
Please re-enter your email address
Year of Birth
Select your preferred gender identity:
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What is your race/ethnicity (select all that apply)?
What language(s) do you primarily speak? 
What is your highest educational degree?
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What was/were your educational degree concentration(s) (i.e., field(s) of study)?
What is your current job title?
Which setting describes your place of work?
Do you work full time or part time?
Clear selection
Estimate the extent to which you provide direct services to young children with disabilities and their families out of your regular job responsibilities:
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How many years of experience do you have as an early childhood service provider or educator?
What is the location of your current work environment?
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Please indicate your preference for participating in our study:
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Please share any questions you have about the study and a member of the research team will follow up with you directly. You may also email Dr. Yaoying Xu with any questions (yxu2@vcu.edu). 
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