Respondent Information Sign-up

Thank you for your interest in participating in PAID market research studies with Eastcoast Research.

Please fill out this survey so we may learn more about you. The more questions you answer, the better we can match you with project opportunities.

The information submitted is strictly confidential. Under no circumstances will your information be sold or solicited to third parties. There will be no attempt to sell products or services to you based on your participation in our studies.

Shortly after you complete this survey, one of our recruiters will call you to complete your profile and discuss upcoming participation opportunities.

You may call our Headquarters at 336.285.5195 for more information or to complete the survey over the phone.

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* 1. Please provide the following information so we may contact you about different studies.

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. What is your Age

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* 3. Please enter your date of birth. (MM/DD/YY)

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* 4. What is your gender?

Female

Male

Prefer to self identify

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* 5. Do you consider yourself part of the LGBTQIA+ community

Yes

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* 6. What is your marital status?

Single

Married

Significant Other

Engaged

Separated

Divorced

Widowed

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* 7. Which of the following best describes your race or ethnic heritage?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Other (please specify)

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* 8. Do you or anyone in your household speak Spanish fluently?

Yes

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* 9. What is your highest level of education you have completed?

Less than High School

High School Graduate or GED

Some College

Associates Degree or Technical/Trade School

College Graduate

Post Graduate Degree

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* 10. Which of the following best describes your employment status?

Employed Full Time

Employed Part Time

Self Employed

Stay at home Parent/ Homemaker

Retired

Full - Time Student

Furloughed

Currently Seeking Employment

Disabled

Other (please specify)

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* 11. Please enter your current occupation and Employer's Name

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* 12. What is your household annual income before taxes?

Less than $25,000

Between $25,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $100,999

Over $100,000

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* 13. Do You have any children under the age of 18?

Yes