*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

*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.)

Northeast (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania)

Midwest OUTSIDE of Illinois (Ohio, Michigan, Indiana, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas)

Illinois

South (Delaware, Maryland, Virginia, West Virginia, Kentucky, North Carolina, South Carolina, Tennessee, Georgia, Florida, Alabama, Mississippi, Arkansas, Louisiana, Texas, and Oklahoma.)

West OUTSIDE of California (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Oregon, Washington, Alaska, and Hawaii.)

California

*5.How would you describe your gender?(Required.)

Male

Female

Other

*6.In what age range do you fall?(Required.)

Under 18

18-24

25-34

35-44

45-54

55+

*7.What is your exact age?(Required.)

*8.For classification purposes only, please tell me which of the following best describes your ethnic background?(Required.)

African-American or Black

Asian or Pacific Islander

Caucasian or White

Hispanic or Latino

Native American Indian

Other (please specify)

*9.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

*10.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

*11.What kind of business are you in?(Required.)

Industry:

Job Title/Description:

Employer:

*12.What kind of business is your spouse/partner in? If none put N/A(Required.)

Industry:

Job Title/Description:

Employer:

*13.Which of the following best describes your annual household income before taxes?(Required.)

Under $35,000

$35,000 - $54,999

$55,000 - $79,999

$80,000 - $104,999

$105,000+

*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)

Entertainment (i.e. TV/movie production, actor, etc.)

Telecommunications or Telephone Company

Social Media, Online or Internet Services

A cable or satellite television provider

Publishing

None of the above

*15.Which of the following describes your household makeup?(Required.)

I am married/living with partner & no kids living at home

I am married/living with partner & kids under 18 years old

I am married/living with partner & kids over 18 years old

I am single and live alone

I am single and live with a roommate / parents

I am single and live with kids under 18 years old

I am single and live with kids over 18 years old