NEW COPY 26-004 Travel 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. Which, if any, of the following technology devices do you own or have access to and use on a regular basis for personal reasons? Please select all that apply. Laptop or desktop computer with a webcam Laptop or desktop computer without a webcam Smartphone with photo and video capabilities Tablet with photo and video capabilities Headphones None of the above Question Title * 3. CONTACT INFO Please provide the following: Name * Address * Apt # if applicable City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * Question Title * 4. Where in the country do you live? Southern CA Northern CA West outside of CA Illinois Midwest outside of Illinois South East Northeast Question Title * 5. What gender do you identify as? Male Female Prefer to Self Describe: Question Title * 6. What age range do you fall into? Under 18 18-28 29-36 37-44 45-60 61-70 71+ Question Title * 7. What is your exact age? Question Title * 8. What is the highest level of education you have completed? Some high school High school diploma and/or GED Trade school/vocational training and/or certificate Military Some college College graduate Post-graduate Other (please specify) Prefer not to Answer Question Title * 9. We are interested in including the views and opinions of individuals with all different racial and ethnic backgrounds in our research. For this reason only, which of the following best describes you? Please select all that apply. Asian and/or Asian American Black and/or African American Caucasian and/or White Latino and/or Hispanic Prefer to Self Describe Prefer not to answer Question Title * 10. Which of the following categories best describes your household’s total annual income before taxes? This is the combined salary of all the household members who work. Would you estimate your household income to be…Please note, we are not interested in your exact income, just your general income category. We are interested in making sure that we include a representative sample of households of all different income levels in our research. Less than $25,000 $25,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 $100,000 to $149,999 $150,000 to $199,999 $200,000 to $249,000 $250,000 to $499,999 $500,000 or more Question Title * 11. Which one of the following describes your current employment status? Employed full time Employed part time Military Homemaker/stay-at-home or full-time parent Student Retired Unemployed Question Title * 12. Please provide your employment information. If not currently employed please indicate your partner's information or your previous employment details: Job Title Company Industry Question Title * 13. When did you last participate in a research group discussion or interview? Never Less than 3 months ago More than 3 months ago, but within the past 6 months More than 6 months ago, but within the past 12 months More than 12 months ago Next
