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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.
Please fill in the following
(Required.)
Name (First and last)
Address
City
State
Zipcode
Phone
Email
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3.
Which area of the country is your permanent residence?
(Required.)
Northeast (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania)
Midwest OUTSIDE of Illinois (Ohio, Michigan, Indiana, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas)
Illinois
South (Delaware, Maryland, Virginia, West Virginia, Kentucky, North Carolina, South Carolina, Tennessee, Georgia, Florida, Alabama, Mississippi, Arkansas, Louisiana, Texas, and Oklahoma.)
West OUTSIDE of California (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Oregon, Washington, Alaska, and Hawaii.)
California
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4.
Are you filling this out for you or your 16/17 year old? if it is for your teen, MAKE SURE THEY ARE WITH YOU and answer as if it were them.
(Required.)
I am filling this out for me
I am filling this out for my 16/17 year old.
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5.
With which gender do you identify?
(Required.)
Male
Female
Non-binary
Other (please specify)
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6.
To which age group do you belong?
(Required.)
Under 16
16-17
18-24
25-34
35-44
45 or over
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7.
What is your exact age?
(Required.)
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8.
With which ethnicity do you identify? Check all that apply
(Required.)
White
Black or African American
Hispanic or Latino
Asian or Asian American
Other (please specify)
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9.
In which state do you live?
(Required.)
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10.
Do you or does anyone in your household work in any of the following industries?
(Required.)
Yes
No
Advertising agency or public relations firm
Yes
No
Marketing research company
Yes
No
Electronics, computer hardware or software industries
Yes
No
Video game or video game system industry
Yes
No
Industry analyst firm
Yes
No
Content creator, streamer and/or influencer
Yes
No
Automotive industry
Yes
No
Broadcast industry or television station
Yes
No
Movie production or film studio
Yes
No
Tourism industry
Yes
No
Energy-supply, including power and gas companies
Yes
No
Education, including teachers and administration
Yes
No
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11.
When was the last time you participated in a market research study of any kind – such as a one-on-one interview, group discussion, opinion survey, or a product test in which you were asked to rate or discuss products, ideas, or advertising?
(Required.)
Within the last 3 months
3-6 months ago
6-12 months ago
Over a year ago or never
