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.
Which, if any, of the following technology devices do you own or have access to and use on a regular basis for personal reasons?
Please select all that apply.
(Required.)
Laptop or desktop computer with a webcam
Laptop or desktop computer without a webcam
Smartphone with photo and video capabilities
Tablet with photo and video capabilities
Headphones
None of the above
*
3.
Which of the following best describes your internet access?
(Required.)
I have consistent access to internet in my home that I can use on my desktop or laptop.
I usually have internet in my home that I can use on my desktop or laptop, but not always.
I usually travel somewhere to use internet on my desktop or laptop (i.e., a friend or family member’s house, work, the public library, a coffee shop, etc.).
*
4.
CONTACT INFO
Please provide the following:
(Required.)
Name
*
Address
*
Apt # if applicable
City/Town
*
State/Province
*
ZIP/Postal Code
*
Email Address
*
Phone Number
*
*
5.
Where in the country do you live?
(Required.)
Southern CA
Northern CA
West outside of CA
Illinois
Midwest outside of Illinois
South
East
Northeast
*
6.
What gender do you identify as?
(Required.)
Male
Female
Non-Binary
Other (please specify)
*
7.
What age range do you fall into?
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-60
61+
*
8.
What is your exact age?
(Required.)
*
9.
Which one of the following best describes your current employment status?
(Required.)
Employed full time
Employed part time
Military
Homemaker/stay-at-home or full-time parent
Student
Retired
Unemployed
*
10.
Please provide your employment information. If not currently employed please indicate your partner's information or your previous employment details:
(Required.)
Job Title
Company
Industry
*
11.
Which of the following industries do you or anyone in your household have professional experience in, if any? Please include past and current occupation(s) in your answer.
Please select all that apply.
(Required.)
Financial Products and Services (e.g., credit cards, payment platforms, etc.)
Banking
Market Research and/or Consumer Insights
Marketing, Advertising, and/or Public Relations
Apparel/Clothing Retail or Manufacturing
Beauty/Personal Care Product Retail or Manufacturing
Consulting
Food Service (e.g. restaurant, catering, etc.)
Grocery, Convenience, or Liquor Store
None of the above
