1. Moms with Kids 11-15yrs old
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1
. Name
Name
First Name
Last Name
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2
. Gender
Gender
Male
Female
3
. Work Phone Number
Work Phone Number
4
. Cell Phone Number
Cell Phone Number
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5
. Best contact number between the hours of 9am-7pm
Best contact number between the hours of 9am-7pm
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6
. Age
Age
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7
. Email Address
Email Address
8
. Race
Race
White or Caucasian
Hispanic or Latino
Black or African-American
Asian-American or Pacific Islander
Native American or American Indian
Other (please specify)
9
. What is the highest level of education you have completed?
What is the highest level of education you have completed?
Some high school
High school graduate
Trade or technical school
Some college
College graduate
Some graduate school
Post graduate degree
10
. Which of the following income groups best represents your total annual household income?
Which of the following income groups best represents your total annual household income?
Under $35,000
$35,000 to less than $45,000
$45,000 to less than $75,000
$75,000 to less than $100,000
$100,000 or above
11
. When was the last time you participated in a research focus group or one on one interview?
When was the last time you participated in a research focus group or one on one interview?
Less than 3 months ago
3-6 months ago
6-12 months ago
More than 1 year ago
Never
12
. Are you currently scheduled to participate in any market research studies?
Are you currently scheduled to participate in any market research studies?
Yes
No
13
. Are you the female head of your household who is responsible for what your child(ren) eats?
Are you the female head of your household who is responsible for what your child(ren) eats?
Yes
No
14
. Do you or does any member of your household, relatives, or close friends work for...
Yes
No
a marketing company or department
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Do you or does any member of your household, relatives, or close friends work for... a marketing company or department Yes
a marketing company or department No
a market research firm or department
a market research firm or department Yes
a market research firm or department No
an advertising or public relations agency
an advertising or public relations agency Yes
an advertising or public relations agency No
a company that sells, manufactures, distributes food or is a dietician or nutritionist
a company that sells, manufactures, distributes food or is a dietician or nutritionist Yes
a company that sells, manufactures, distributes food or is a dietician or nutritionist No
15
. Please tell me how many children you have living in your household in the folloing catagories.
Please tell me how many children you have living in your household in the folloing catagories.
Male 1-10yrs old
Male 11yrs old
Male 12yrs old
Male 13yrs old
Male 14yrs old
Male 15yrs old
Male over 16yrs old
Female 1-10yrs old
Female 11yrs old
Female 12 yrs old
Female 13yrs old
Female 14yrs old
Female 15yrs old
Female over 16yrs old
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16
. Do you or does anyone in your household currently have any food allergies or dietary restrictions, such as lactose intolerance, diabetes or food sensitivities?
Do you or does anyone in your household currently have any food allergies or dietary restrictions, such as lactose intolerance, diabetes or food sensitivities?
Yes
No
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17
. Are you or is anyone in your household a vegetarian or avoids meat for specific medical reasons, religious reasons or because of personal choice?
Are you or is anyone in your household a vegetarian or avoids meat for specific medical reasons, religious reasons or because of personal choice?
Yes
No
18
. Are you the primary grocery shopper (do half or more of the family grocery shopping)?
Are you the primary grocery shopper (do half or more of the family grocery shopping)?
Yes
No
19
. Thinking about frozen breakfast sandwiches with meat, cheese and eggs and other sandwich like items (such as Hot Pockets/Lean Pockets, Toaster Scrambles) that you heat and eat, which of the following statements best describes how you feel about them?
Thinking about frozen breakfast sandwiches with meat, cheese and eggs and other sandwich like items (such as Hot Pockets/Lean Pockets, Toaster Scrambles) that you heat and eat, which of the following statements best describes how you feel about them?
I love them and let my kids eat them everyday if they want
I like them and let my kids eat them but they have some drawbacks, for example, they don’t heat evenly, not that easy to prepare, are too processed, not that fresh... ect...
I used to let them eat them but stopped because they aren’t that good for them and they got tired of how they taste
I let my kids try them and they didn’t like them so I will never buy them again
20
. Please tell me which, if any, of the following food brands you DISLIKE and tend to avoid?
Please tell me which, if any, of the following food brands you DISLIKE and tend to avoid?
Sara Lee
Kelloggs
Aunt Jemima
Hormel
Oscar Mayer
Jimmy Dean
General Mills
I would consider all of the brand above
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