*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.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.(Required.)

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

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

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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

Southern CA

Northern CA

West outside of CA

Illinois

Midwest outside of Illinois

South

East

Northeast

*5.What gender do you identify as?(Required.)

Male

Female

Prefer to Self Describe:

*6.What age range do you fall into?(Required.)

Under 18

18-28

29-36

37-44

45-60

61-70

71+

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

*8.What is the highest level of education you have completed?(Required.)

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

*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.(Required.)

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

*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.(Required.)

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

*11.Which one of the following describes your current employment status?(Required.)

Employed full time

Employed part time

Military

Homemaker/stay-at-home or full-time parent

Student

Retired

Unemployed

*12.Please provide your employment information. If not currently employed please indicate your partner's information or your previous employment details:(Required.)

Job Title

Company

Industry

*13.When did you last participate in a research group discussion or interview?(Required.)

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