Skip to content
*
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.
FOR IN PERSON RESEARCH:
In order to gain admittance to the facility, you need to bring:
A Photo ID
Reading glasses if you need them
Please make sure to self assess your health prior to the session and we ask that you cancel in advance if you are sick with Cold/Flu/Covid-19 symptoms.
Frequently we do not allow cell phones, smart watches, cameras or any electronic/digital devices into the research. There is a possiblity you will be asked to leave your devices with our front desk team where they will be kept securely during the research.
If qualified and based on these participation requirements, are you willing to participate in this in-person interview?
(Required.)
Yes
No
*
3.
Please fill in the following
(Required.)
Name
Address
City/Town
ZIP/Postal Code
Email Address
Phone Number
*
4.
Are you available to participate in an in-person paid research session to be conducted on Wednesday July 9, 2025 from 8:30am to 6:00pm Pacific Time?
(Required.)
Yes
No
*
5.
With which gender do you identify?
(Required.)
Male
Female
Non-binary
Other (please specify)
*
6.
To which age group do you belong?
(Required.)
Under 18
18 – 24
25 – 34
35 – 44
45 – 54
55 – 64
65-74
Over 74
*
7.
What is your exact age?
(Required.)
*
8.
With which ethnicity do you identify?
(Required.)
White
Hispanic or Latino
Black or African American
Asian or Asian American
Other (please specify)
*
9.
Have you participated in a marketing survey or market research in the past 6 months (e.g., mall intercept, phone survey, focus group)?
(Required.)
Yes
No
*
10.
Have you ever participated in any of the following types of research projects?
(Required.)
Yes
No
Mystery Shopping
Yes
No
Taste Test
Yes
No
Mock Jury/Legal Study
Yes
No
Political Focus group
Yes
No
*
11.
Are you a U.S. Citizen?
(Required.)
Yes
No
