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. Please fill in the following Name Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 3. Which area of the country is your permanent residence? Northeast (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania) Midwest (Ohio, Michigan, Indiana, Wisconsin, Illinois, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas) South (Delaware, Maryland, Virginia, West Virginia, Kentucky, North Carolina, South Carolina, Tennessee, Georgia, Florida, Alabama, Mississippi, Arkansas, Louisiana, Texas, and Oklahoma.) West (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, California, Oregon, Washington, Alaska, and Hawaii.) Question Title * 4. With which gender do you identify? Male Female Non-binary Other (please specify) Question Title * 5. Please tell me which of the following best describes your ethnic background? African-American or Black Asian or Pacific Islander Caucasian or White Hispanic or Latino Native American Indian Other (please specify) Question Title * 6. To which age group do you belong? Under 18 18-29 30-35 36-49 50-59 60 and over Question Title * 7. What is your exact age? Question Title * 8. Sometimes we need to speak with people who have and who haven’t been to market research studies in the past. When, if ever, was the last time you participated in a market research study? Question Title * 9. What was the topic of that study? Question Title * 10. We are interested in talking to people with a variety of backgrounds. Have you, or have any members of your family, worked (either currently or at some point) in any of the following types of companies? Check all that apply Advertising or public relations Travel or hospitality Market research company or department Banking or financial institutions Education, government or public sector None of the above Question Title * 11. What is the highest level of education you have completed? Some high school High school graduate Some college College graduate Some graduate school Graduate school+ Question Title * 12. For classification purposes, which of the following best describes your current employment status? I am employed full-time I am employed part-time I am a homemaker I am a full-time student I am retired I am not currently employed Question Title * 13. What is your Job Title, Company Name and Industry? Job Title Company Name Industry Question Title * 14. What is your marital status? Single Married or Co-habitating Divorced, Widowed or Separated Next
