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. Please answer the following Name Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 3. What part of the country do you live in? Northeast (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania) Midwest (Ohio, Illinois, Michigan, Indiana, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas) South (Delaware, Maryland, Virginia, West Virginia, Kentucky, North Carolina, South Carolina, Tennessee, Georgia, Florida, Alabama, Mississippi, Arkansas, Louisiana, Texas, and Oklahoma.) West (Montana, California, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Oregon, Washington, Alaska, and Hawaii.) Question Title * 4. Are you…? Female Male Non Binary Prefer to self describe Question Title * 5. Which age group do you belong in? Under 18 18-24 25-29 30-39 40-49 50+ Question Title * 6. What is your exact age? Question Title * 7. Which of the following best describes your current employment status? Employed Full time (30+ hours per week) Employed Part time Stay at home parent or caretaker Student Unemployed / Non-working Retired Question Title * 8. We are interested in speaking to people who work in various industries. What is your current occupation? Job Title: Company Name: Industry: Question Title * 9. Do you or does anyone in your household work in any of the following industries? Please select all that apply. Advertising, marketing, or market research Journalism or the media Electronics, computer hardware or software industries eCommerce / Online retailer Telecommunications Motion picture studio or video company Tourism Healthcare Education Energy supplier, including power and gas companies None of the above Next
