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Focus Group Research: Financial Planning
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1.
What is your First Name?
(Required.)
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2.
What is your Last Name?
(Required.)
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3.
What is the best phone number we can reach you at?
(Required.)
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4.
What is your email address?
(Required.)
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5.
What is your gender?
(Required.)
Male
Female
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6.
What is your age?
(Required.)
Under 20
20 to 29
30 to 39
40 to 49
50 or over
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7.
What is your current relationship status?
(Required.)
Married / Common law
In a relationship
Single, never married
Divorced / Widowed
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8.
What is your employment status? Are you…?
(Required.)
Working full time
Working part time
Self-employed
A full or part-time student
A full-time homemaker
Currently unemployed, and actively looking for work
Retired
Other (please specify)
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9.
Are you responsible for managing your personal and/or household finances?
(Required.)
Yes, I am primary responsible
Yes, I am jointly responsible
No, I am not responsible
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10.
Do you have any children who live with you full-time? Would you say…?
(Required.)
Yes, I have at least one child who lives with me
Yes, I have child(ren) but they do not live with me
No, I have no children
11.
To enter our draw for a FREE iPad, include the names and numbers of some people that would be interested in getting paid for their opinions! (Remember, each referral earns you one ballot.)
Referral Name 1:
Referral Phone Number 1:
Referral Name 2:
Referral Phone Number 2:
Referral Name 3:
Referral Phone Number 3:
