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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.
By proceeding, you certify that all answers provided in this application are truthful, accurate, and complete to the best of your knowledge. You also confirm that you have completed this application independently, without the assistance of AI tools, chatbots, or other external aids.
Please note:
The client reserves the right to disqualify and turn away any participant without compensation if any information provided is found to be untruthful, inaccurate, or generated by AI.
Do you agree with the conditions above?
Yes
No
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3.
CONTACT INFO
Please provide the following:
(Required.)
Name
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Address
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Apt # if applicable
City/Town
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State/Province
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ZIP/Postal Code
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Email Address
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Phone Number
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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
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5.
How would you describe your gender?
(Required.)
Male
Female
Other
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6.
In what age range do you fall?
(Required.)
Under 16
16-17
18-24
25-34
35-44
45-54
55+
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7.
What is your exact age?
(Required.)
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8.
For classification purposes only, would you say you are of Hispanic, Latino or Spanish origin?
(Required.)
Yes
No
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9.
For classification purposes only, which of these best describe your racial or ethnic background?
(Required.)
Black or African American
Asian or Asian American
White
Native American Indian
Other (please specify)
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10.
How long have you lived in the US?
(Required.)
Under 6 months
6 months to 2 years
3-5 years
6-10 years
11-20
Over 20 years
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11.
What is the highest level of education you have completed?
(Required.)
Some high school
High school graduate
Currently in college
1-3 years of college
College graduate
Some graduate school
Graduate school
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12.
For classification purposes, which of the following best describes your current employment status?
(Required.)
I am employed full-time
I am employed part-time
I am a homemaker
I am a full-time student
I am retired
I am not currently employed
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13.
Which of the following best describes your annual household income before taxes?
(Required.)
Under $35,000
$35,000 - $49,999
$50,000-$74,999
$75,000-$99,999
$100,000+
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14.
Have you, or have any members of your family, worked (either currently or at some point) in any of the following types of companies?
(Required.)
Marketing Research
Advertising, Marketing or Public Relations Firm
Media (i.e., TV, radio, entertainment industry, newspaper)
Social Media, Online or Internet Services
A cable or satellite television provider
Sports media
A professional or collegiate sports league, team, conference, or governing body
None of the above
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15.
How many children under the age of 18 live at home with you?
(Required.)
0
1
2
3
4
5
6 or more
