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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.
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
Financial Incentive Info
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.
3.
By proceeding, you certify that all answers provided in this application are truthful, accurate, and complete to the best of your knowledge. You also confirm that you have completed this application independently, without the assistance of AI tools, chatbots, or other external aids.
Please note:
The client reserves the right to disqualify and turn away any participant without compensation if any information provided is found to be untruthful, inaccurate, or generated by AI.
Do you agree with the conditions above?
Yes
No
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4.
CONTACT INFO
Please provide the following:
(Required.)
Name
*
Address
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Apt # if applicable
City/Town
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State/Province
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ZIP/Postal Code
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Email Address
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Phone Number
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5.
What gender do you identify as?
Male
Female
Non-Binary
Other (please specify)
6.
What age range do you fall into?
Under 18
18-24
25-34
35-44
45-55
56-64
65+
7.
What is your exact age?
8.
Which of the following best describes you?
American Indian or Alaska Native
Asian
Black or African American
Hispanic / Latino
Native Hawaiian or Other Pacific Islander
White
Other (please specify)
9.
Have you or has any member of your immediate family worked in any of the following industries, either currently or in the past?
Yes
No
Market research
Yes
No
Advertising, marketing, or public relations
Yes
No
Video game development, publishing, marketing, esports, streaming, or gaming media
Yes
No
Entertainment, film, television, radio, journalism, or media
Yes
No
Technology
Yes
No
Retail
Yes
No
Education
Yes
No
Healthcare
Yes
No
Finance
Yes
No
10.
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
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11.
Please provide your employment information. If not currently employed please indicate your previous employment details:
(Required.)
Job Title
Company
Industry
12.
Whis is your total annual household income before taxes?
Less than $25,000
$25,000 to $49,999
$50,000 to $74,999
$75,000 to $99,999
$100,000 to $149,999
$150,000 or more
13.
When was the last time you participated in a market research study? What was the topic?
In the past 3 months
3 to 6 months ago
Within the past year
More than a year ago
Never
14.
Which of the following activities do you do regularly, meaning at least weekly?
Play games on PC or Console
Play games on mobile phone
Watch movies or TV through a streaming service
Watch gaming content online
Read books, comics, or graphic novels
Play tabletop or board games
Follow gaming news
None of the above
