*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.CONTACT INFO Please provide the following:(Required.)

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

*3.Where in the country do you live?(Required.)

Southern CA

Northern CA

West outside of CA

Illinois

Midwest outside of Illinois

South

East

Northeast

*4.Which of the following do you most closely identify with?(Required.)

Male

Female

Non-binary

*5.What is your exact age?(Required.)

*6.Which age range do you fall in?(Required.)

Under 18

18-27

28-45

46-59

60+

*7.Which of the following describes your household makeup?(Required.)

I am married or living with partner with no kids living at home

I am married or living with partner with kids under 18 years old who live with me

I am married or living with partner with kids over 18 years old who live with me

I am single and live alone

I am single and live with a roommate / parents

I am single and live with kids under 18 years old

I am single and live with kids over 18 years old

*8.Are you a homeowner? That is, do you own the place where you live?(Required.)

I am a homeowner

I am currently a renter, but I plan to buy a home within the next 12 months

I am currently a renter, and I do not plan to buy a home within the next 12 months

I do not currently pay for rent

9.For classification purposes only, 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)