*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
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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.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

*3.CONTACT INFO Please provide the following:(Required.)

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

4.What gender do you identify as?

Male

Female

Non-Binary

Other (please specify)

5.What age group do you fall into?

Under 18

18-27

28-34

35-45

46-55

56+

6.What is your exact age?

7.In order to represent everyone equally, which of the following best describes your ethnic background?

Caucasien/White

African American/Black

Hispanic/Latin

Asian

Other (please specify)

8.Into which of the following categories does your total annual household income fall?

Less than $20,000

$20,000 -$29,999

$30,000 -$39,999

$40,000-$64.999

$65,000-$79,999

$80,000-$99,999

$100,000 or More

9.What is the highest level of education you have completed?

Some high school

Graduated high school

Some college or trade school

Graduated college

Completed post-graduate school

10.What is your current employment status?

Working Full time

Working Part Time

Seeking work / Unemployed

Stay-at-Home / Homemaker

Retired

Student

11.Often people who work for businesses related to the products and services research can bring insight to our work. Do you, or any member of your immediate family, or a close friend work full-time or part-time now or in the past for any of the following types of companies or services?

An advertising agency, an in-house advertising department, graphic design firm or public relations firm

A market research company or the market research department in a company

A manufacturer, distributor, or retailer of food products

Any business related to new product development or consulting

A casual dining or fast casual restaurant

Culinary or food service class or program

A radio or TV broadcasting station, a newspaper or magazine publishing company

A sales promotion or marketing company

The food industry

The USDA or FDA

A consultant to any of the above

None of the above

12.Are you currently participating or scheduled to participate in any market research projects with us or any other company?

Yes

No

13.When, if ever, was the last time you participated in a market research discussion group?

Within the last 3 months

Within the last 6 months

6 months or more

Never