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. With which gender do you identify? Male Female Non-binary Other (please specify) Question Title * 4. To which age group do you belong? Under 18 18-24 25-34 35-44 45-54 55-64 Over 64 Question Title * 5. What is your exact age? Question Title * 6. For classification purposes only, 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 * 7. When, if ever, did you do your last market research study? And what was it on? Question Title * 8. Which of the following describes your household makeup? Select all that apply I live alone I like with a spouse/significant other I live with a roommate / parents I live with kids under 18 years old I live with kids over 18 years old Question Title * 9. Which best describes your marital status? Single – never married Married Divorced/widowed/separated Other (please specify) 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 Marketing Research Advertising, Marketing or Public Relations Firm Media (i.e. TV, radio, entertainment industry, newspaper) Telecommunications or Telephone Company Social Media, Online or Internet Services – including digital marketing, social networking Technology (i.e. software, gaming development) A cable, satellite or streaming television provider 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 I am not currently employed due to Covid-19 Question Title * 13. What is your Job Title, Company Name and Industry? (Partner if you're a Homemaker) Job Title Company Name Industry Question Title * 14. Which of the following best describes your household income? Under $30,000 $30,000 - $49,999 $50,000-$74,999 $75,000-$99,999 $100,000+ Question Title * 15. Are you a parent of a child/children under 18? Yes No Next
