Thank you for completing this brief survey to determine whether you qualify for our upcoming focus groups in Upstate New York. This information is for research and screening purposes only and will be kept confidential. It will not be shared, and you will not receive marketing offers as a result of completing this questionnaire.People who participate in the focus group will be paid $75 at the end of the group.If you have any problems with this survey, please contact susan@opinionworks.com. Question Title * 1. What is the zip code of your residence? Question Title * 2. Please provide contact information so we know how to get in touch with you: Name Email address (please confirm carefully): City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Mobile phone number: Landline phone number: Question Title * 3. What is the highest level of education you have completed? Less than a high school diploma High school diploma or GED Attended some college Bachelor's Degree or 4-year college degree Post-graduate work such as Master's Degree, Doctorate, etc. Question Title * 4. What is your age? 18 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 or more Question Title * 5. Are you Hispanic or Latino? Yes No Question Title * 6. What is your racial identity? Mark any that apply. White African-American or Black Asian Native American Native Hawaiian or other Pacific Islander Other (please specify) Question Title * 7. How did you hear about us? Thank you very much. Your responses have been recorded. We will be in touch with you to provide more details about the New York groups. Please keep in mind that if you do not qualify this time, we may have more groups in the coming months and may be back in touch. Thanks for your interest! Done
