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. Please fill in the following Name Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 3. Which area of the country is your permanent residence? 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 Question Title * 4. Which of the following best describes your gender? Male Female Non-Binary Other (please specify) Question Title * 5. With which ethnicity do you identify? Check all that apply White Black or African American Hispanic or Latino Asian or Asian American Other (please specify) Question Title * 6. To which age group do you belong? Under 18 18-23 24-28 29-35 36-44 45-55 Over 55 Question Title * 7. What is your exact age? Question Title * 8. What is your total combined annual household income? 1. Less than $30,000 2. $30,000-$39,999 3. $40,000 - $49,999 4. $50,000-$59,999 5. $60,000-$69,999 6. $70,000-$79,999 7. $80,000-$89,999 8. $90,000-$99,999 9. $100,000-$124,999 10. $125,000-$149,999 11. $150,000+ Question Title * 9. What is the highest level of education you’ve completed? 1. Some high school or less 2. High school diploma 3. Some college, no degree 4. Associate’s degree/trade school/technical school 5. Undergraduate degree 6. Some post graduate study 7. Post graduate degree Question Title * 10. Which of the following best describes your employment status? 1. Employed full-time 2. Employed part-time 3. Self-employed 4. Full-time student 5. Part-time student 6. Full-time homemaker 7. Not employed 8. Retired Question Title * 11. Do you have kids under the age of 18? Yes No Next
