1. Demographic information

Plaza Research Houston is looking for renters 21 to 50 years of age to discuss Household Services. This study will take place on Wednesday, November 7th in the evening. If you qualify and are chosen to participate, you will receive $75 for participating in the 2-hour focus group discussion.

Please answer the questions below. If you look like a match, we will contact you by telephone.

**Due to the large response to our surveys, we are only able to contact those that look like a match. Please continue to answer future studies, as you may be a match to those.

* 1. Please provide us with the following information. We will be contacting you by telephone if you seem like a match.

* 2. Alternate Contact number

* 3. When was the last time you participated in a focus group discussion and what was the topic?

* 4. What is your gender?

* 5. Employment

* 6. What is your current employment information? If retired or unemployed, please list your last employer/occupation.

* 7. Employment information for all adults in your household

* 8. What is your age?

* 9. What is your marital status?

* 10. Please list the ages and gender of all kids in the household, if any.

* 11. Ethnicity

* 12. Which of the following best describes your annual household income before taxes?

* 13. What is the last level of education you completed

* 14. Do you currently rent or own the home you live in?

* 15. Which of these best describes your home type?