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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. Lastly, you confirm that you live within the United States and are not suing a VPN to change your location in any way.
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.
Please Fill in the following
(Required.)
Name (First and Last)
Address
City
Zip Code
Phone
Email
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4.
With which gender do you identify?
(Required.)
Male
Female
Non-binary
Other (please specify)
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5.
With which ethnicity do you identify? Check all that apply
(Required.)
Hispanic or Latino (Spanish, Mexican, Latin America: Colombian, Brazilian, etc., Caribbean: Cuban, Puerto Rican, Dominican, etc.)
White European (e.g. German, Irish, English, Italian)
Middle Eastern or North African (e.g. Lebanese, Turkish, Egyptian)
Black American or of African Descent (e.g. Jamaican, Haitian, Nigerian, Ethiopian, Somali)
Asian (e.g. Chinese, Taiwanese, Korean, Japanese, Vietnamese, Indian, Indonesian, Filipino, Thai)
Native Hawaiian or other Pacific islander (e.g. Samoan, Chamorro, Tongan, Fijian)
Native American, Inuit, or Aleut (e.g. Navajo Nation, Nome Eskimo Community, Cherokee)
Other (please specify)
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6.
Within which age group do you fall?
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
65+
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7.
What is your exact age?
(Required.)
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8.
Are you or any member of your immediate family currently employed in any of the following industries or roles?
(Required.)
yes
no
An advertising, marketing, or public relations agency
yes
no
A market research company or a role conducting market research
yes
no
A role directly involved in designing, developing, manufacturing, marketing, or selling computers, tablets, or computer operating systems
yes
no
Other technology roles, such as general IT support, software development, gaming, or app development
yes
no
Education, including teaching, schools, or educational administration
yes
no
A company that manufactures or sells electronics, games, or apps
yes
no
Newspaper, magazine, book publishing, or professional media/blog publishing
yes
no
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9.
What city and state do you live in?
(Required.)
City
State
*
10.
Are you the parent or legal guardian of any children aged 17 years or younger who live in your household?
(Required.)
Yes
No
