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Focus Group - Initial Questionnaire 2012
1.
Please enter your contact information
Name
Address
Address 2
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Email Address
Phone Number
2.
Do you have wifi?
Yes
No
3.
What type of device will you be using to participate in the virtual focus group?
Phone
Laptop
Ipad
Tablet
Desktop
Other (please specify)
4.
Have you ever participated in a discussion group or a focus group for research in the past?
Yes
No
5.
If yes, what was the topic?
6.
What is your age?
7.
What is the highest level of education you have completed?
High School or GED
Associate Degree or Tech/Business School
Bachelor Degree
Master Degree
Other (please specify)
8.
Major
9.
What is your current occupation
10.
List the name of your current or last employer.
11.
What is your current marital status?
Married
Divorced/seperated
Single (never married)
Living with a partner
Widowed
12.
What is your spouses/partner occupation?
13.
Are there any other adults living in your household?
Yes
No
14.
If yes, who?
Roommate
Family
Partner
Other (please specify)
15.
If yes, what is their occupation?
16.
Do you have children?
Yes
No
17.
If yes, what are their ages?
18.
Are you registered to vote?
Yes
No
19.
Do you have a valid MN Drivers License?
Yes
No
20.
Have you ever served on jury duty?
Yes
No
21.
If yes, when and where?
22.
Have you, anyone in your family or any of your close friends ever been employed in any of the following fields:
Media
Legal or Court System
Insurance claims or with an insurance company
Attorney or working in an attorney's office
23.
What is your ethnic or racial background?
Asian
Black/African
White
Hispanic/Latino
Native American
Pacific Islander
Other
Other (please specify)
24.
What category does your annual household income fall into?
< $20,000
$20,000 - $40,000
$40,000 - $60,000
$60,000 - $80, 000
> $80,000
25.
Have you, anyone in your family or a close friend, or your employer ever been involved in a lawsuit, suing or being sued, making a statement as a witness, or some other lawsuit situation?
Yes
No
26.
Have you ever been seriously injured?
Yes
No
27.
Do you consider yourself more of a conservative or more of a liberal?
Conservative
Liberal
28.
Do you consider yourself more of a conservative or more of a liberal?
Conservative
Liberal
29.
Is it more important for a child to have respect for elders or independence?
Respect for elders
Independence
30.
Is it more important for a child to have obedience or be self reliant?
Obedience
Self Reliant
31.
Is it more important for a child to have good manners or be curious?
Good Manners
Curious
32.
is it more important for a child to be considerate or well-behaved?
Considerate
Well behaved
33.
Do you consider yourself religious?
Yes
No
34.
How many times have you attended a church service in the last year?
0 - 5
5 - 10
10 - 20
more than 20
35.
Where did you hear about this focus group?
Newspaper - print
Newspaper - online
Facebook
Craigslist
Other Social Media
Other
Current Progress,
0 of 35 answered