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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
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Address
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Apt # if applicable
City/Town
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State/Province
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ZIP/Postal Code
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Email Address
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Phone Number
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3.
In order to participate in this research, you would be required to complete a brief tech check, to ensure that your computer and internet are sufficient to allow you to participate. This tech check must be done on the computer and internet connection that you will be using for the group. Are you willing to do this?
(Required.)
Yes
No
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4.
Do you have access to a computer in order to participate in this online focus group? By this we mean a desktop or full laptop computer, not a tablet such as an iPad or Playbook or Chromebook.
(Required.)
Yes
No
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5.
Does your computer have a keyboard?
(Required.)
Yes
No
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6.
Does your computer have a working camera and a working microphone.
(Required.)
Yes
No
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7.
Does your computer have the most recent version of one of the following browsers (choose all that apply):
(Required.)
Chrome
Firefox
Microsoft Edge
Safari
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8.
Is your computer connected to a VPN (Virtual Private Network)?
(Required.)
Yes
No
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9.
Do you have access to reliable High Speed Internet to participate in this online focus group?
(Required.)
Yes
No
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10.
To take part in the session, you will need to have access to a quiet space where you will be undisturbed for the full two hours that the research is taking place, but that is also close enough to your router to ensure a good internet connection. This quiet space also needs to be well lit so that the researchers are able to see your face on the webcam. Are you able to accommodate these requirements?
(Required.)
Yes
No
11.
On a scale of 1-10, where 1 is not at all comfortable and 10 is extremely comfortable; please tell me how comfortable you are with each of the following activities:
Not at all comfortable 1
2
3
4
5
6
7
8
9
Extremely comfortable 10
Typing on a keyboard
Not at all comfortable 1
2
3
4
5
6
7
8
9
Extremely comfortable 10
Conducting a basic internet search
Not at all comfortable 1
2
3
4
5
6
7
8
9
Extremely comfortable 10
Attaching a picture to an email or uploading photos/videos to a website
Not at all comfortable 1
2
3
4
5
6
7
8
9
Extremely comfortable 10
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12.
With which gender do you identify?
(Required.)
Male
Female
Gender diverse
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13.
Are you or is any member of your household or your immediate family employed in…?
(Required.)
Market Research
Marketing
Public Relations
Any Media (Print, Radio, TV, Web)
A member of SAG/AFTRA
Advertising
Any bank, credit union, trust company or financial institution
Credit card company
Investments, mutual funds, financial analysis or planning
Accountant/Accounting firm
Insurance company
None of the Above
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14.
We have been asked to group participants by age. So that we may do this accurately, what is your age please?
(Required.)
Under 20 years
20 - 24 years
25 – 29 years
30 – 34 years
35 – 39 years
40 - 44 years
45 - 49 years
50 years or older
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15.
What is your marital status?
(Required.)
Married/cohabitating
Single
Divorced/separated/widowed
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16.
What is your working status?
(Required.)
Full Time (35 hrs. +)
Part Time (under 35 hrs.)
Homemaker/Stay at home parent
Full Time College/University Student
Retired
Unemployed/Looking for work
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17.
And what is your spouse/partner’s working status?
(Required.)
I don't have a spouse/partner
Full Time (35 hrs. +)
Part Time (under 35 hrs.)
Homemaker/Stay at home parent
Full Time College/University Student
Retired
Unemployed/Looking for work
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18.
What is your current occupation?
(Required.)
Job Title:
Employer:
Industry:
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19.
What is your spouse/partners current occupation? (If none put N/A)
(Required.)
Job Title:
Employer:
Industry:
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20.
Into which category may we place your total annual household income or personal income if you are single?
(Required.)
Under $35,000
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $124,999
$125,000 - $149,999
$150,000 - $174,999
$175,000 - $199,999
$200,000 or more
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21.
Do you have any children under 18 years of age living at home?
(Required.)
Yes
No
