Political Study #1545 Your data will only be used for market research purposes and we will not sell participant information. Question Title * 1. Name Question Title * 2. Address Question Title * 3. Email Question Title * 4. Phone Question Title * 5. Gender: Male Female Non-binary Prefer to self describe (please specify) Question Title * 6. Age: Question Title * 7. When, if ever, was the last time you participated in a focus group, individual interview, or similar market research discussion? In the past 0-6 months In the past 6-12 months More than 12 months ago I have never participated in a focus group or similar market research discussion Question Title * 8. How would you describe your race/ethnicity? Please select all that apply. Caucasian or White Black or African American Hispanic or Latino Caribbean Asian Middle Eastern or North African Native Hawaiian or other Pacific Islander American Indian or Alaskan Native Other (please specify) Question Title * 9. What is your marital status? Single Married Unmarried and living with a partner Separated Divorced Widowed Question Title * 10. Do you have children who live with you at home? Please select all that apply I'm currently pregnant Yes, and they are under 18 Yes, and they are 18 or older No, I do not have children in my home Question Title * 11. What are your child(ren) age(s)? (Put 0 if no kids) Question Title * 12. What is the highest level of schooling you have completed? Some high school or less High school graduate - high school diploma or GED Some college credit, but less than 1 year 1 or more years of college credit, no degree Associate's degree (AA, AS, etc.) Bachelor's degree (BA, BS, etc.) Master's degree (MA, MS, MBA, etc.) Professional degree (MD, DDS, JD, etc.) Doctorate degree (PhD, EdD, etc.) Question Title * 13. Which of the following best describes your annual household income? Under $20,000 At least $20,000 but less than $40,000 At least $40,000 but less than $60,000 At least $60,000 but less than $80,000 At least $80,000 but less than $100,000 At least $100,000 Question Title * 14. What is your current employment status? Self Employed/Business Owner Employed full time Employed part time Homemaker/Stay-at-home parent Student Retired Unemployed Next
