BOOK TO ACTION: IMMIGRATION
About the book
In the Country We Love: My Family Divided
by Diane Guerrero
Book Request Form
Implied Consent to Participate in Research
Information collected from this form will be used to improve the programs of and for informational reporting on activities connected to the Book to Action program. The information gathered will be used for research on community engagement.
The questions will be about your participation in the Book to Action: Immigration program.
You have been invited to complete this form because of your desire to be involved in the program.
You must be 18 years of age or older to participate.
There are no risks to you in participating in this survey. You may choose to participate or not.
Completion of this form indicates your consent to the above conditions.
The form should take approximately 5 minutes to complete.
Any questions or concerns should be directed to the principal investigator, Andrea Wells, in the Center for Community Engagement at
City of Residence
Student at Cal State East Bay
Staff at Cal State East Bay
Faculty at Cal State East Bay
Alum of Cal State East Bay
Which event do you plan to attend?
Keynote *Separate Ticket Required
Book Discussion at City Hall
Book Discussion at Cal State East Bay
Where would you like to pick up your copy of In the Country We Love: My Family Divided?
Hayward Public Library - 835 C St, Hayward, CA 94541
CSU East Bay - For students, faculty, and staff ONLY. You will be contacted to arrange a pick up time.
Please tell us, why you are interested in Book to Action: Immigration?
What do you hope to learn from reading this book and/or participating in the events?
How do you think the local community can best engage with and respond to current issues relating to immigration?
By submitting this book request form you agree to attend a Book to Action: Immigration event.
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About the book