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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 Info
Financial Incentive Info
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.
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2.
Please fill in the following
(Required.)
Name
Address
City/Town
State/Province
ZIP/Postal Code
Email Address
Phone Number
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3.
With which gender do you identify?
(Required.)
Male
Female
Non-binary
Other (please specify)
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4.
To which age group do you belong?
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
Over 64
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5.
What is your exact age?
(Required.)
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6.
For classification purposes only, 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)
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7.
When, if ever, did you do your last market research study? And what was it on?
(Required.)
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8.
Which of the following describes your household makeup? Select all that apply
(Required.)
I live alone
I like with a spouse/significant other
I live with a roommate / parents
I live with kids under 18 years old
I live with kids over 18 years old
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9.
Which best describes your marital status?
(Required.)
Single – never married
Married
Divorced/widowed/separated
Other (please specify)
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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.)
Marketing Research
Advertising, Marketing or Public Relations Firm
Media (i.e. TV, radio, entertainment industry, newspaper)
Telecommunications or Telephone Company
Social Media, Online or Internet Services – including digital marketing, social networking
Technology (i.e. software, gaming development)
A cable, satellite or streaming television provider
None of the above
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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+
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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
I am not currently employed due to Covid-19
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13.
What is your Job Title, Company Name and Industry? (Partner if you're a Homemaker)
(Required.)
Job Title
Company Name
Industry
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14.
Which of the following best describes your household income?
(Required.)
Under $30,000
$30,000 - $49,999
$50,000-$74,999
$75,000-$99,999
$100,000+
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15.
Are you a parent of a child/children under 18?
(Required.)
Yes
No
