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. CONTACT INFO Please provide the following: Name * Address * Apt # if applicable City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * Question Title * 3. Which do you identify as? Male Female Other (prefer to self-describe) Question Title * 4. What is your age range? Under 25 25-29 30-39 40-44 45-55 56+ Question Title * 5. What is your exact age? Question Title * 6. Thinking about the job(s) and occupations you and members of your family, close friends and relatives hold. Do any have jobs that are in the following types of companies or have related job titles: A food or beverage manufacturer or processor A food or beverage wholesaler, distributor or retailer A grocery store or supermarket A dietician or nutritionist A marketing or market research company A newspaper, magazine, TV or radio station An advertising agency or public relations company A direct mail or promotional agency None of the above Question Title * 7. Which of the following best describes your current employment status: Employed full-time Employed part-time Don’t work outside the home/homemaker Full-time or part-time student Temporarily unemployed/looking for work Question Title * 8. What is your occupation? And if you are not currently employed, or are retired, please list your previous position. Job Title Industry Type of Business Question Title * 9. What is the occupation of the other people in your household? Person #1 Job Title Industry Type of Business Person #2 Job Title Industry Type of Business Question Title * 10. When was the last time you participated in a market research discussion or a one-on-one interview about products or services? Less than 6 months ago Over 6 months ago Never Next
