*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:
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Adler Weiner Privacy Policy(Required.)

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.

*2.Please fill in the following(Required.)

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

*3.Which area of the country is your permanent residence?(Required.)

Northeast (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania)

Midwest (Ohio, Michigan, Indiana, Wisconsin, Illinois, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas)

South (Delaware, Maryland, Virginia, West Virginia, Kentucky, North Carolina, South Carolina, Tennessee, Georgia, Florida, Alabama, Mississippi, Arkansas, Louisiana, Texas, and Oklahoma.)

West (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, California, Oregon, Washington, Alaska, and Hawaii.)

*4.With which gender do you identify?(Required.)

Male

Female

Non-binary

Other (please specify)

*5.Please tell me which of the following best describes your ethnic background?(Required.)

African-American or Black

Asian or Pacific Islander

Caucasian or White

Hispanic or Latino

Native American Indian

Other (please specify)

*6.To which age group do you belong?(Required.)

Under 18

18-29

30-35

36-49

50-59

60 and over

*7.What is your exact age?(Required.)

*8.Sometimes we need to speak with people who have and who haven’t been to market research studies in the past. When, if ever, was the last time you participated in a market research study?(Required.)

9.What was the topic of that study?

*10.We are interested in talking to people with a variety of backgrounds. Have you, or have any members of your family, worked (either currently or at some point) in any of the following types of companies? Check all that apply(Required.)

Advertising or public relations

Travel or hospitality

Market research company or department

Banking or financial institutions

Education, government or public sector

None of the above

*11.What is the highest level of education you have completed?(Required.)

Some high school

High school graduate

Some college

College graduate

Some graduate school

Graduate school+

*12.For classification purposes, which of the following best describes your current employment status?(Required.)

I am employed full-time

I am employed part-time

I am a homemaker

I am a full-time student

I am retired

I am not currently employed

*13.What is your Job Title, Company Name and Industry?(Required.)

Job Title

Company Name

Industry

*14.What is your marital status?(Required.)

Single

Married or Co-habitating

Divorced, Widowed or Separated