*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:
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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.Please fill in the following

Name

Address

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

*3.Which area of the country is your permanent residence?(Required.)

Northeast (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania)

Midwest (Ohio, Michigan, Indiana, Wisconsin, Illinois, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas)

South (Delaware, Maryland, Virginia, West Virginia, Kentucky, North Carolina, South Carolina, Tennessee, Georgia, Florida, Alabama, Mississippi, Arkansas, Louisiana, Texas, and Oklahoma.)

West (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, California, Oregon, Washington, Alaska, and Hawaii.)

*4.With which gender do you identify?(Required.)

Male

Female

Non-binary

Rather not say

Other (please specify)

*5.To which age group do you belong?(Required.)

Under 18

18-24

25-36

37-45

46-54

55-65

Over 65

*6.What is your exact age?(Required.)

*7.With which ethnicity do you most identify?(Required.)

White

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

*8.Have you participated in the past six months or are you scheduled to participate in any market research studies, such as focus groups, one-on-one interviews?(Required.)

No

Yes(please specify)

*9.Are you currently scheduled to participate in any marketing research?(Required.)

Yes

No

*10.What is your current employment status?(Required.)

Working full time (one primary role/position) (>30 hrs. per week)

Working part time /or multiple separate jobs

Laid-off/looking for work

A stay-at-home parent

Student (full or part-time)

Retired

Other (please specify)

*11.Which of the following best describes the industry you work in?(Required.)

Advertising

Public Education

Government

Non-profit

Healthcare / Medicine

Hospitality / Customer Service

Marketing

Manufacturing

Construction

Sales / Retail

Transportation

Stay-at-home parent

Retired

Information technology (eg. computer software or hardware, website design, etc)

Student

Unemployed

None of the above

*12.What is your Job Title, Company Name and Industry(Required.)

Job Title

Company Name

Industry

*13.Do you have any of the following connections to Google? Check all that apply(Required.)

I currently work at Google

I worked at Google in the past

I have an immediate family member who works for Google

I have a close friend who works for Google

I currently work for a company that provides services to Google

I have worked at a company that provides services to Google in the past

None of the above