*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.

2.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

*3.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

4.Thanks again for your interest in the Social Issues study! The group will take place in Westwood for 6 hours on Thursday, August 27th. If you qualify and participate, you will receive $275 plus $25 for a mandatory pre survey.

Please check off which times, if any, you'd be available. If you qualify and we have a spot for you we will be in touch!

Please keep in mind checking off times does NOT mean you are recruited for the project; you MUST be contacted by a recruiter.

Thursday, August 27th 12pm-6pm

I am not available

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

Name *

Address *

Apt # if applicable

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

6.Are you a U.S. citizen?

Yes

No

7.In what County do you live?

Los Angeles

Other

8.Are you currently a registered voter in your County?

Yes

No

9.Do you have a valid California driver’s license or California ID Card?

Yes

No

10.Have you ever participated in a focus group or market research study?

Yes

No

11.Have you participated in any studies of the following topics within the past 6 months?

Political Study

Consumer Product/Taste Test

Legal Focus Group/ Mock Jury

Entertainment/ Movies/ Music

None of the above

12.What gender do you identify with?

Female

Male

Non-binary/Other

13.What age category do you fall under?

Under 18

18-20

21-24

25-29

30-39

40-49

50-59

60-64

65-69

70-75

Over 75

14.What is your age and date of birth?

Exact age

DOB

15.What is your ethnic background?

Anglo/White/Caucasian

Hispanic/Latino

Black/African American

Asian/Pacific Islander

Native American

Other (please specify)

16.What is the highest level of education you have achieved?

GED/Less than high school

High School Graduate

Vocational/Technical School

Some college

Associate’s degree

Bachelor’s degree

Graduate degree(please specify)

17.What is your employment status? (Select all and track)

Full-time

Part-time

Self-employed

Gig Worker (DoorDash/UberEats, Uber/Lyft Driver, Instacart, Task Rabbit)

Homemaker

Government Worker

Retired

Unemployed

Full-time Student

Disabled

18.What is your current job title and employer's name? If you are unemployed or retired, please list previous employment information

Job title

Employer's name

Industry