1.What is your first and last name?

2.What is your phone number (please put in ***-***-**** format

3.What is your email address? 

4.What is your age?

5.What is your race/ethnicity?

6.What was the last level of education you have completed? 

High School Graduate or Less

Technical or Vocational School

Some College

Graduated College

Graduate/Professional School

7.Which of the following best describes your work status at this time? 

Full time

Part time

Self employed

Full time homemaker

Unemployed

Full time student

Retired

8.And to be sure that we are getting a good mx of respondents, could you please tell me your occupation? Job title, Company, Industry. If you are a homemaker, please tell us the name of the company for which you previously worked.

Also, if applicable, what is your spouse or partner's occupation? 

9.Are you registered to vote?

10.And what city and county do you reside in?

11.Despite how you feel today, which are you currently registered as

Democrat

Republican

Independent

Something else

12.If you answered Democrat, would you say are a Strong, Not so strong, or do you just lean Democrat?

13.If you answered Republican, would you say are a Strong, Not so strong, or do you lean just lean Republican?

14.If you answered Independent, which party do you lean?

15.Generally speaking, which do you consider yourself to be? 

Very Conservative

Somewhat Conservative

Moderate

Liberal on most issues

16.Who is your favorite historical figure? Please share the two or three reasons why you selected him/her

17.Have you participated in a focus group or group discussion either in person or online within the past year? If so, what was the topic of the group/discussion?

18.Do you have any physical condition such as a seeing or hearing impairment that would make it difficult for you to look at and view materials and participate in a small group discussion for about 2 hours

19.We are conducting 2 focus groups on April 13th. One group is at 4pm and the other is at 6:30pm. Depending on your answers will depend on which time slot you fall into. YOU CANNOT PICK YOUR OWN TIME. Upon completion of the group, you will be compensated $150 cash. We are also doing two $50 early bird drawings which means if you show up at least 15 minutes (or sooner) prior to the group, you will be entered into the drawing. If you are one minute late, you will NOT be entered. Are you available for either time slot, and are you interested in participating?