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1.
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?
(Required.)
Yes
No
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2.
Please fill in the following informaion
(Required.)
Name (first and last)
Phone Number
Email
Town
Zipcode
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3.
In which County is your permanent address?
(Required.)
Los Angeles
Orange County
San Bernardino
Ventura
Riverside
Other (please specify)
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4.
With which gender do you identifyt?
(Required.)
Male
Femaile
Non-binary
Other (please specify)
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5.
With which ethniciity do you mostly identify
(Required.)
White, Caucasian, European, European-American
Black, African-American, Caribbean, African, Caribbean-American
Hispanic, Latino, or Spanish origin
Asian-American, Asian, Pacific Islander
Other (please specify)
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6.
To which age group do you belong?
(Required.)
Under 18
18-22
23-28
29-35
36-44
45-54
55-60
61 - 64
65 and over
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7.
What is your exact age?
(Required.)
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8.
Which of the following best describes your current employment status?
(Required.)
Employed full time
Employed part time
Stay-At-Home Parent or Homemaker
Student
Retired
Not employed / Looking for work
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9.
What is your current Job Title, Company Name and Industry?
(Required.)
Job Title
Company Name
Industry
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10.
Do you or does anyone in your household work in any of the following industries?
(Required.)
Yes
No
Advertising, marketing, or market research
Yes
No
Journalism or the media
Yes
No
Hardware or software company
Yes
No
Computer/tablet/smartphone hardware or software
Yes
No
Technology or computer consulting
Yes
No
Manufacturing
Yes
No
Telecommunications
Yes
No
Education
Yes
No
Retail
Yes
No
Healthcare
Yes
No
Banking and Finance
Yes
No
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11.
When did you last participate in a market research study of any kind?
(Required.)
In the last 3 months
3-6 months ago
Over 6 months ago
Never
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12.
On what topics have you participated in marketing research in the past year?
(Required.)
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13.
Which, if any, of the following devices do you personally own and use? Check all that apply
(Required.)
Smartphone (e.g. iPhone, Android phone, etc.)
Laptop computer
Desktop computer
ablet (e.g. iPad, Surface, Galaxy Tablet, etc.)
Video game console (e.g. Xbox One, PlayStation 4, Nintendo Switch, etc.)
4K or Ultra High Definition (UHD) TV
None of the above
