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. CONTACT INFO Please provide the following: Name * Address * Apt # if applicable City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * Question Title * 3. 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 * 4. What is your gender? Male Female Non-Binary/Other Question Title * 5. What is your current age? Question Title * 6. In what age range do you fall? Under 18 18-24 25-34 35-44 45-54 55-64 65-69 70+ Question Title * 7. What is your race or ethnic heritage? If appropriate, you may select more than one answer if this best describes you. White, Caucasian, European, European-American Black, African-American, Caribbean, African, Caribbean-American Hispanic, Latino, or Spanish origin Asian-American, Asian, Pacific Islander American Indian, Native American Other (please specify) Question Title * 8. Which of the following best describes your current employment status? Employed full time Employed part time Stay-At-Home Parent or Homemaker Student Retired Not employed / Looking for work Question Title * 9. We are interested in speaking to people who work in various industries. What is your current occupation? Job Title: Employer: Industry: Question Title * 10. Do you or does anyone in your household work in any of the following industries? Hardware or software company Technology or computer consulting Manufacturing Telecommunications Entertainment or media Advertising, marketing, or market research None of the above Next
