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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 Info
Financial Incentive Info
Adler Weiner Privacy Policy
(Required.)
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.
2.
Please fill in the following
(Required.)
Name (First and last)
Address
City
State
Zip Code
Phone
Email
3.
Which area of the country is your permanent residence?
(Required.)
Northeast (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania)
Midwest OUTSIDE of Illinois (Ohio, Michigan, Indiana, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas)
Illinois
South (Delaware, Maryland, Virginia, West Virginia, Kentucky, North Carolina, South Carolina, Tennessee, Georgia, Florida, Alabama, Mississippi, Arkansas, Louisiana, Texas, and Oklahoma.)
West OUTSIDE of California (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Oregon, Washington, Alaska, and Hawaii.)
California
4.
With which gender do you identify?
(Required.)
Male
Female
Non-binary
Other (please specify)
5.
To which age group do you belong?
(Required.)
Under 18
18-24
25-34
35-41
42-54
55-64
65-70
Over 70
6.
What is your exact age?
(Required.)
7.
Do you or does anyone in your household work in any of the following industries? Check all that apply
(Required.)
Yes
No
Advertising, marketing, or market research
Yes
No
Journalism or the media
Yes
No
eCommerce / Online retailer
Yes
No
Technology
Yes
No
Telecommunications
Yes
No
Motion picture studio or video company
Yes
No
Tourism
Yes
No
Healthcare
Yes
No
Education
Yes
No
Energy supply, including power and gas companies
Yes
No
8.
Are you of Hispanic, Latino, or Spanish origin
(Required.)
Yes
No
9.
With which ethnicity do you identify? Check all that apply
(Required.)
White
Black or African American
Hispanic or Latino
Asian or Asian American
Other (please specify)
10.
Which state do you live in?
(Required.)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia (Washington, D.C.)
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
11.
When did you last participate in a market research study of any kind?
(Required.)
In the last 3 months
3-6 months ago
Over 6 months ago
Never
12.
For what topics have you participated in marketing research in the past year
(Required.)
13.
Which of the following best describes your current employment status? Check all that apply
(Required.)
Gig worker
Employed full-time (40+ hours per week)
Employed part-time (less than 40 hours per week)
Self-employed or freelancer
Unemployed and seeking work
Unemployed and not seeking work
Student
Retired
