*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:
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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

*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?

Male

Female

Non-Binary

Other (please specify)

6.What age range do you fall into?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

7.What is your exact age?

8.What ethnicity do you identify as?

Black or African American

Hispanic or Latino

White

Asian or Asian American

Middle Eastern or North African

Native Hawaiian or other Pacific Islander

American Indian or Alaska Native

Another race

9.Please indicate into which of these yearly income groups your household would fall.

Less than $25,000

$25,000 to $29,999

$30,000 to $39,999

$40,000 to $49,999

$50,000 to $74,999

$75,000 to $99,999

$100,000 to $149,999

$150,000 or more

10.What is the highest level of education you have completed?

Attended some high school

Graduated from high school/GED

Graduated from vocational/trade school or other 2-year program

Attended some college

Graduated from college

Post-graduate college study

11.Are you …? (Select one answer)

Employed full-time (or work 30 hours or more per week)

Employed part-time (or work less than 30 hours per week)

Retired

A homemaker

An unemployed student

Currently unemployed

12.In the past 3 months, have you participated in any research about new television programs?

Yes

No

13.Do you or does any member of your immediate family (SPOUSE, CHILD, OR PARENT) have any current or past employment history with any of the following industries? (Mark as MANY as apply.)

Advertising

Market Research

Radio or television (including cable)

Entertainment industry

Press coverage of the media or entertainment industry

None of the above