1. New alternative school concept

Thank you for signing up with the Qualitative Insights database. We are currently having a study regarding a new alternative school concept. It will pay $75 for your time. It will be an online discussion done anywhere you like as long as there is a computer. It will be on July 10 and 11, an hour a day. If you are interested please fill out the following questionnaire and if you qualify a recruiter will contact you to follow up. If you know anyone who will also be interested in this please pass the link along. Thanks!

* 1. What is your gender?

* 2. What is your age?

* 3. What state do you live in?

* 4. What is the highest level of education you have completed?

* 5. What grade did you last attend in high school?

* 6. What is the make of your cell phone?

* 7. What is the model of your cell phone?

* 8. Who is your cell phone provider?

* 9. Which best describes your ethnic background?

* 10. Which of the following do your parents associate?

* 11. Which of the follwoing best describes your relationship status:

* 12. Have you ever served in any brance of the military?

* 13. Were you referred? If so, by whom? Please give us their name and last name. Thanks!

* 14. Please fill out the following: (It will be kept strictly confidential.)