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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.
2.
By proceeding, you certify that all answers provided in this application are truthful, accurate, and complete to the best of your knowledge. You also confirm that you have completed this application independently, without the assistance of AI tools, chatbots, or other external aids.
Please note:
The client reserves the right to disqualify and turn away any participant without compensation if any information provided is found to be untruthful, inaccurate, or generated by AI.
Do you agree with the conditions above?
Yes
No
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3.
CONTACT INFO
Please provide the following:
(Required.)
Name
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Address
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Apt # if applicable
City/Town
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State/Province
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ZIP/Postal Code
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Email Address
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Phone Number
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4.
Where in the country do you live?
(Required.)
Southern CA
Northern CA
West outside of CA
Illinois
Midwest outside of Illinois
South
East
Northeast
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5.
With which of the following do you most closely identify?
(Required.)
Male
Female
Non-binary, gender fluid, agender, two-spirit
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6.
What is your age?
(Required.)
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7.
In what age range do you fall?
(Required.)
24 years or younger
25 - 37
38 - 44
45 - 52
53 - 66
67 years or older
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8.
What is your marital status?
(Required.)
Married
Single
Widowed
Divorced
Separated
Living with significant other
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9.
Which of these describe your household? Please select all that apply.
(Required.)
I live alone
I live with roommates
I live with a spouse or partner
I live with children under 18
I live with children over 18
I have adult children no longer living at home
I live with other family members
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10.
What is the age and gender of each person living in your household (including you)?
(Required.)
Self:
AGE/GENDER
:
Household member:
AGE/GENDER:
Household member:
AGE/GENDER:
Household member: A
GE/GENDER:
Household member:
AGE/GENDER:
Household member:
AGE/GENDER:
Household member:
AGE/GENDER:
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11.
When was the last time that you participated in a marketing research study?
(Required.)
In the past 6 months
7-12 months ago
More than 12 months ago
Never
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12.
If you participated in any market research studies in the last 6 months please list the topic. If none please put N/A
(Required.)
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13.
Are you currently scheduled to participate in any marketing research studies?
(Required.)
Yes
No
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14.
What is your current employment status?
(Required.)
A full-time employee
Working part-time
Laid-off / looking for work
A stay-at-home parent
Student (full or part-time)
Retired
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15.
Are you or any member of your household employed by any of the following types of companies?
(Required.)
Advertising/Public Relations
News Media (such as TV, radio or newspaper)
Financial Services (consultant, bank manager or employed by a brokerage or investment firm)
Market Research (such as a firm or the market research department within a company)
Website or Internet-related company (such as Google, Yahoo, etc.)
Telecommunications company (such as Time Warner, Comcast, AT&T, etc.)
A manager or employee of a home improvement store
As a repairer, remodeler and/or restorer
In a specialty trade related to construction, building, repair, remodeling and/or restoration (e.g., plumber, HVAC, electrician, carpenter, etc.)
Residential Property Manager or Contractor
Manufacturing for plumbing or other connected products
Medical professional, e.g. Doctor, Nurse, Dentist, etc.
Academic professional, e.g. Teacher, Professor, Councilor, etc.
First Responder, e.g. Police Officer, Firefighter, EMT, etc.
None of the above
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16.
Which of the following, if any, currently applies to your life?
(Required.)
You are just starting your career
You are newly married
You are in a committed relationship / partnered where you live together
You are considering having children in the future, but you do not currently have children
You have children and plan to add more to your family
You have a new baby in your home
You are planning to add a pet in your home soon or have a new pet at home
You are caring for aging parents
You are a grandparent
You own a second/vacation home or are in the process of purchasing one
You are actively downsizing or have downsized your home
None of these
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17.
Which of the following best describes your home ownership?
(Required.)
Are a first-time homeowner, purchased your home within the past 5 years, and still live in it
Are a homeowner, but you are not living in your first home
Do not currently own your own home, but plan on purchasing your first home in the next 12 months
Do not currently own a home and do NOT plan on purchasing your first home in the next 12 months
