Question Title * 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 InfoFinancial Incentive InfoAdler Weiner Privacy Policy 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. Question Title * 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? Yes No PARENTS PLEASE FILL OUT THE FOLLWING INFORMATION Question Title * 3. Please answer the following Name Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 4. Which of the following do you identify? Male Female Non-Binary / I prefer to self-identify Prefer not to answer Question Title * 5. Which of the following age groups do you belong to? 18-24 25-34 35-44 45-54 Question Title * 6. What is your exact age? Question Title * 7. Which of the following best describes you? American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Hispanic Prefer not to say Other (please specify) Question Title * 8. What is the highest level of education you have completed? Some high school High school graduate Currently in college Some college College graduate Some graduate school Graduate school Question Title * 9. For classification purposes, which of the following best describes your current employment status? 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 Question Title * 10. Please provide your employment information. If not currently employed please indicate your partner's information or your previous employment details: Job Title Company Industry Question Title * 11. Which of the following best describes your household’s total annual income? Less than $25,000 $25,000 to less than $50,000 $50,000 to less than $75,000 $75,000 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+ Question Title * 12. Do you use any of the following paid, online streaming video services? Please select all that apply. Netflix YouTube Premium Hulu Disney Plus HBO Max Amazon Prime Video Apple TV+ Other (please specify) None of the above Question Title * 13. Do you have a child(ren) between the ages of 13 and 17? Yes No Next
