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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.
FOR IN PERSON RESEARCH:
In order to gain admittance to the facility, you need to bring:
A Photo ID
Reading glasses if you need them
Please make sure to self assess your health prior to the session and we ask that you cancel in advance if you are sick with Cold/Flu/Covid-19 symptoms.
Frequently we do not allow cell phones, smart watches, cameras or any electronic/digital devices into the research. There is a possiblity you will be asked to leave your devices with our front desk team where they will be kept securely during the research.
If qualified and based on these participation requirements, are you willing to participate in this in-person interview?
(Required.)
Yes
No
3.
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
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4.
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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5.
What is your gender identity? (SELECT ONE)
(Required.)
Male
Female
Non-Binary
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6.
May I have your age please?
(Required.)
Under 18
18 – 25
26 – 34
35 – 41
42 – 54
55 – 69
Over 69
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7.
What is your exact age?
(Required.)
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8.
What is your current employment status?
(Required.)
Employed Full Time
Employed Part Time
Part or Full Time Student
Full Time Homemaker
Retired
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9.
Sometimes the type of work people do affects the products they buy. Are you, or is any member of your household, currently or formerly, employed in any of the following occupations? (SELECT ALL THAT APPLY)
(Required.)
A marketing or market research firm or department of a company
An advertising agency or public relations firm
A media company such as radio, magazine, newspaper, television, etc.
A graphic or packaging design firm
A tech related company
A manufacturer, retailer or wholesaler of computers or computer supplies
None of the Above
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10.
Please provide your employment information. If not currently employed please indicate your partner's information or your previous employment details:
(Required.)
Job Title
Company
Industry
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11.
Please provide the employment information for your spouse/anyone else in the household. If you don't have anyone in the Household, please skip
(Required.)
Job Title
Company
Industry
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12.
Which of the following, if any, have you done within the past 24 months? (SELECT ALL THAT APPLY)
(Required.)
Use an external storage device I own to store or transfer data (USB Flash Drive, Portable SSD, SD card, CFexpress, etc.)
Pay for a cloud storage service to store or transfer data (iCloud, OneDrive, etc.)
Buy a new PC to use for productivity or gaming
Buy a new mobile phone
Use a digital camera (not phone) to take pictures and/or videos
Buy a new USB cable to charge my device or transfer files to another device
Set up a new home network
Buy new accessories for my devices (charging stations, etc.)
Make use of a digital smart home security product or vehicle dash cam (camera, doorbell, baby monitor, etc.)
None of the above
