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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
45-55
56-64
Over 64
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5.
What is your exact age?
(Required.)
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6.
Which of the following best describes you?
(Required.)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Other (please specify)
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7.
Which of the following best describes your household’s total monthly income, after taxes?
(Required.)
Less than $25,000
$25,000 to less than $50,000
$50,000 to less than $75,000
$50,000 to less than $100,000
$100,000 to less than $125,000
$125,000 to less than $150,000
$150,000 to less than $250,000
$250,000 to less than $500,000
$500,000 to less than $1,000,000
$1,000,000 or more
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8.
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?
(Required.)
Yes
No
Marketing Research
Yes
No
Healthcare
Yes
No
Advertising, Marketing or Public Relations Firm
Yes
No
Technology
Yes
No
Media (i.e. TV, radio, entertainment industry, streaming service, gaming, newspaper)
Yes
No
Retail
Yes
No
Manufacturing
Yes
No
Telecommunications or Telephone Company
Yes
No
Social Media, Online or Internet Services – including digital marketing, social networking
Yes
No
Automotive
Yes
No
A cable or satellite television provider
Yes
No
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9.
What is your Job Title, Company Name and Industry? If a homemaker please fill in for you partner. If retired please fill in information based on your last job.
(Required.)
Job Title
Company Name
Industry
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10.
What is the highest level of education you have completed?
(Required.)
Some high school
High school graduate
Currently in college
Some college
College graduate
Some graduate school
Graduate school
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11.
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
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12.
Which of the following activities do you do regularly? (i.e. on a weekly basis) Check all that apply
(Required.)
Play games on my phone or tablet
Go shopping
Play organized sports
Read
Watch movies
Cook
Hike
Garden
Watch movies/TV through a subscription streaming service
Play games on PC/console
