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. Which of the following best describes your current gender/gender identity? Male Female Non-binary Question Title * 4. What is your current age? Under 18 18-24 25-34 35-41 42-54 55-64 65 – 70 Over 70 Question Title * 5. What is your exact age? Question Title * 6. Which following categories best describes your ethnic or racial background or heritage? White, Caucasian, European, European-American Hispanic or Latino Black, African-American, Caribbean, African, Caribbean-American Asian-American, Asian, Pacific Islander American Indian, Native American Other (please specify) Question Title * 7. 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 * 8. When did you last participate in a market research study of any kind? In the last 3 months 3-6 months ago Over 6 months ago Never Next
