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. CONTACT INFO Please provide the following: Name * Address * Apt # if applicable City/Town * State/Province * ZIP/Postal Code * Email Address * Phone Number * Question Title * 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? Yes No Question Title * 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. Yes No Question Title * 5. Does your computer have a keyboard? Yes No Question Title * 6. Does your computer have a working camera and a working microphone. Yes No Question Title * 7. Does your computer have the most recent version of one of the following browsers (choose all that apply): Chrome Firefox Microsoft Edge Safari Question Title * 8. Is your computer connected to a VPN (Virtual Private Network)? Yes No Question Title * 9. Do you have access to reliable High Speed Internet to participate in this online focus group? Yes No Question Title * 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? Yes No Question Title * 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 Typing on a keyboard Not at all comfortable 1 Typing on a keyboard 2 Typing on a keyboard 3 Typing on a keyboard 4 Typing on a keyboard 5 Typing on a keyboard 6 Typing on a keyboard 7 Typing on a keyboard 8 Typing on a keyboard 9 Typing on a keyboard Extremely comfortable 10 Conducting a basic internet search Conducting a basic internet search Not at all comfortable 1 Conducting a basic internet search 2 Conducting a basic internet search 3 Conducting a basic internet search 4 Conducting a basic internet search 5 Conducting a basic internet search 6 Conducting a basic internet search 7 Conducting a basic internet search 8 Conducting a basic internet search 9 Conducting a basic internet search Extremely comfortable 10 Attaching a picture to an email or uploading photos/videos to a website Attaching a picture to an email or uploading photos/videos to a website Not at all comfortable 1 Attaching a picture to an email or uploading photos/videos to a website 2 Attaching a picture to an email or uploading photos/videos to a website 3 Attaching a picture to an email or uploading photos/videos to a website 4 Attaching a picture to an email or uploading photos/videos to a website 5 Attaching a picture to an email or uploading photos/videos to a website 6 Attaching a picture to an email or uploading photos/videos to a website 7 Attaching a picture to an email or uploading photos/videos to a website 8 Attaching a picture to an email or uploading photos/videos to a website 9 Attaching a picture to an email or uploading photos/videos to a website Extremely comfortable 10 Question Title * 12. With which gender do you identify? Male Female Gender diverse Question Title * 13. Are you or is any member of your household or your immediate family employed in…? 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 Question Title * 14. We have been asked to group participants by age. So that we may do this accurately, what is your age please? 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 Question Title * 15. What is your marital status? Married/cohabitating Single Divorced/separated/widowed Question Title * 16. What is your working status? Full Time (35 hrs. +) Part Time (under 35 hrs.) Homemaker/Stay at home parent Full Time College/University Student Retired Unemployed/Looking for work Question Title * 17. And what is your spouse/partner’s working status? 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 Question Title * 18. What is your current occupation? Job Title: Employer: Industry: Question Title * 19. What is your spouse/partners current occupation? (If none put N/A) Job Title: Employer: Industry: Question Title * 20. Into which category may we place your total annual household income or personal income if you are single? 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 Question Title * 21. Do you have any children under 18 years of age living at home? Yes No Next
