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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.
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2.
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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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
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4.
What is your gender?
(Required.)
Male
Female
Non-Binary/Other
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5.
What is your current age?
(Required.)
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6.
In what age range do you fall?
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
65-69
70+
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7.
What is your race or ethnic heritage? If appropriate, you may select more than one answer if this best describes you.
(Required.)
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)
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8.
Which of the following best describes your current employment status?
(Required.)
Employed full time
Employed part time
Stay-At-Home Parent or Homemaker
Student
Retired
Not employed / Looking for work
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9.
We are interested in speaking to people who work in various industries. What is your current occupation?
(Required.)
Job Title:
Employer:
Industry:
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10.
Do you or does anyone in your household work in any of the following industries?
(Required.)
Hardware or software company
Technology or computer consulting
Manufacturing
Telecommunications
Entertainment or media
Advertising, marketing, or market research
None of the above
