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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
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.
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2.
CONTACT INFO
Please provide the following:
(Required.)
Name
City/Town
Email Address
Phone Number
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3.
What is your gender?
(Required.)
Male
Female
Non-Binary/Other
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4.
Are you a US Citizen with valid state ID?
(Required.)
Yes
No
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5.
Are you a resident of Los Angeles County, CA?
(Required.)
Yes
No
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6.
What is your age?
(Required.)
under 18
18-24
25-44
45-64
65-75
over 75
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7.
Are you a full-time student?
(Required.)
Yes
No
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8.
Are you a convicted felon?
(Required.)
Yes
No
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9.
Are you or any member of your household currently under summons for jury duty?
(Required.)
Yes
No
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10.
Can you read and write in the English language with proficiency?
(Required.)
Yes
No
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11.
Have you participated in a focus group in the last 2 years?
(Required.)
Yes
No
