Question Title * 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 InfoFinancial Incentive InfoAdler Weiner Privacy Policy 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. Question Title * 2. Please fill in the following Name Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 3. Which area of the country is your permanent residence? Northeast (Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania) Midwest (Ohio, Michigan, Indiana, Wisconsin, Illinois, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas) South (Delaware, Maryland, Virginia, West Virginia, Kentucky, North Carolina, South Carolina, Tennessee, Georgia, Florida, Alabama, Mississippi, Arkansas, Louisiana, Texas, and Oklahoma.) West (Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, California, Oregon, Washington, Alaska, and Hawaii.) Question Title * 4. With which gender do you identify? Male Female Non-binary Rather not say Other (please specify) Question Title * 5. To which age group do you belong? Under 18 18-24 25-36 36-45 46-54 55-65 Over 65 Question Title * 6. What is your exact age? Question Title * 7. With which ethnicity do you most identify? White Black or African American Hispanic or Latino Asian or Asian American American Indian or Alaska Native Native Hawaiian or other Pacific Islander Another race Question Title * 8. Have you participated in the past six months or are you scheduled to participate in any market research studies, such as focus groups, one-on-one interviews? No Yes(please specify) Question Title * 9. Are you currently scheduled to participate in any marketing research? Yes No Question Title * 10. What is your current employment status? Working full time (one primary role/position) (>30 hrs. per week) Working part time /or multiple separate jobs Laid-off/looking for work A stay-at-home parent Student (full or part-time) Retired Other (please specify) Question Title * 11. Which of the following best describes the industry you work in? Advertising Public Education Government Non-profit Healthcare / Medicine Hospitality / Customer Service Marketing Manufacturing Construction Sales / Retail Transportation Stay-at-home parent Retired Information technology (eg. computer software or hardware, website design, etc) Student Unemployed None of the above Question Title * 12. What is your Job Title, Company Name and Industry Job Title Company Name Industry Question Title * 13. Do you have any of the following connections to Google? Check all that apply I currently work at Google I worked at Google in the past I have an immediate family member who works for Google I have a close friend who works for Google I currently work for a company that provides services to Google I have worked at a company that provides services to Google in the past None of the above Next
