Houston Studies - Mock Trial #2 October 2016 Survey

Plaza Research Houston is conducting a Mock Trial for Montgomery County residents. The mock trial will take place at an off site location on Tuesday, October 11th, 2016 throughout the day. If you qualify and participate, you will receive $225 for 9 hours. Breakfast, lunch, and complimentary parking will be provided.

Please answer the questions below. If you look like a match, we will contact you by telephone.

**Due to the large response to our surveys, we are only able to contact those that look like a match. Please continue to answer future studies, as you may be a match to those.

1.Please provide us with the following information. We will be contacting you by telephone if you seem like a match.(Required.)

Name:

ZIP:

Email Address:

Phone Number:

2.Alternate Contact number

3.What is your Employment Status?(Required.)

Please list the occupation, company and industry for all employed members of your household

4.Are you male or female?(Required.)

Male

Female

5.What is your age?(Required.)

6.Which of the following best describes your current relationship status?(Required.)

7.What is the highest level of school you have completed or the highest degree you have received?(Required.)

8.Are you White, Black or African-American, American Indian or Alaskan Native, Asian, Native Hawaiian or other Pacific islander, or some other race?

Some other race (please specify)

10.Do you have children under the age of 18 living at home?(Required.)

Yes

No

If yes, please list the age and gender of each

Houston Studies - Mock Trial #2 October 2016

2.Deographic Section