Question Title * 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 InfoFinancial Incentive InfoAdler Weiner Privacy Policy 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. Question Title * 2. CONTACT INFO Please provide the following: Name * Address * Apt # if applicable City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * Question Title * 3. Where in the country do you live? Southern CA Northern CA West outside of CA Illinois Midwest outside of Illinois South East Northeast Question Title * 4. What state do you live in? Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Question Title * 5. What gender do you identify as? Male Female Non-Binary Other (please specify) Question Title * 6. What age range do you fall into? Under 18 18-24 25-34 35-44 45-54 55-64 65+ Question Title * 7. What is your exact age? Question Title * 8. What is your current employment status? Are you… Employed full-time (30+ hours per week) Employed part-time (Less than 30 hours per week) Freelance, gig or contract worker Self-employed full or part-time Student (full or part-time) Full-time wife/husband or parent Retired Currently unemployed Other (please specify) Question Title * 9. In which of the following industries, if any, are you, yourself, currently employed? Agriculture Construction Mining Trucking / Truck transportation Accommodation (Travel/Hoteling/Hospitality) Architecture / Engineering Arts / Entertainment / Recreation Professional Services (e.g. accounting, consulting, legal, real estate) Financial services (e.g. banking and insurance) Food services corporate offices (not restaurants or food preparation) Market Research Media / Marketing / Advertising Technology Retail corporate offices (not physical stores) Education Government (National, state and local) / Public Administration Healthcare corporate offices (not healthcare practitioners or hospitals) Manufacturing Telecommunications Forestry, Fishing and Hunting Utilities and Power Wholesale trade Other (please specify) None of the above Next
