Question Title * 1. This survey is being conducted by Adler Weiner Research in order to determine your eligibility for a focus group or interview about which you have been contacted. At no point are your individual answers ever sold or shared with our clients (aggregate data or anonymized summaries of the overall survey information may possibly be shared with our clients, however). This survey serves solely as a means for screening. Once the project has been completed this data will be deleted. For more information please see:Right to Opt-Out InfoFinancial Incentive InfoAdler Weiner Privacy Policy I consent to Adler Weiner Research collecting, storing and processing my personal information for the purpose of determining my eligibility for this market research focus group or interview. I understand and consent to the following: That should I be eligible for participation in this market research focus group or interview, my contact information (phone, email, and home address) may be shared with the client for purposes related only to this particular project and are not limited to: screening calls to further determine eligibility, sending of "homework" or pre-session assignments via email, allowing access to an online platform via email, or for in-home interviews conducted at your residence. Question Title * 2. FOR IN PERSON RESEARCH:In order to gain admittance to the facility, you need to bring: A Photo ID Reading glasses if you need them Please make sure to self assess your health prior to the session and we ask that you cancel in advance if you are sick with Cold/Flu/Covid-19 symptoms. Frequently we do not allow cell phones, smart watches, cameras or any electronic/digital devices into the research. There is a possiblity you will be asked to leave your devices with our front desk team where they will be kept securely during the research. If qualified and based on these participation requirements, are you willing to participate in this in-person interview? Yes No Question Title * 3. CONTACT INFO Please provide the following: Name * Address * Apt # if applicable City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * Question Title * 4. Which gender identity do you most identify with? Male Female Non-binary Prefer not to say Question Title * 5. Are you or is any member of your immediate family currently employed in any of the following types of business? (READ LIST, CHECK ALL THAT APPLY) An advertising, marketing, or public relations firm Marketing research firm A newspaper, magazine, book publisher, blog, or website A company that manufactures or sells consumer electronics, games, or apps ( An actor in commercials, TV or movies) A social media company, software design, or web applications company None of the above Question Title * 6. What is your age? Under 21 22-26 27-34 35-44 45-54 55-60 61 or older Question Title * 7. What is your exact age? Question Title * 8. What is your marital status? Single Married/Living with partner Divorced/Separated/Widowed Question Title * 9. Which of the following best describes you? I am not the parent of any child(ren) I am the parent of a child (or children) under the age of 18 years I am the parent of children under the age of 18 years AND over the age of 17 years I am the parent of a child (or children) all over the age of 17 years Question Title * 10. You mentioned you are the parent of children over the age of 17 years. Do any of your children live outside of your household? Yes No Next
