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Questionnaire
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1.
Please provide your email address
(Required.)
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2.
First and Last Name:
(Required.)
First Name
Last Name
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3.
Please provide your full street address:
(Required.)
Address
City
State
Zip Code
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4.
What is the best phone number to reach you?
(Required.)
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5.
How did you find us?
(Required.)
Social Media
QR Code
Speaking Engagement
Referral
Craigslist
Email
Other (please specify)
6.
If you selected referral, who referred you?
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7.
What is your preferred method of contact?
(Required.)
Email
Phone call
Text
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8.
Are you available for:
(Required.)
In person focus groups
Virtual/online focus groups
Both
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9.
Gender
(Required.)
Male
Female
Other
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10.
How old are you?
(Required.)
Under 18
18-20
21-30
31-40
41-50
51-60
61-70
71+
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11.
What ethnicity do you most identify with?
(Required.)
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Another race
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12.
Do you have any children?
(Required.)
No
1
2
3
4
More than 4
13.
What are the age ranges of your children?
0-5 years old
6-10 years old
11-15 years old
16-17 years old
18 and over
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14.
Choose 5 words that would best describe yourself.
(Required.)
Word 1
Word 2
Word 3
Word 4
Word 5
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15.
What is the highest level of education you have completed?
(Required.)
Did not attend school
1st grade
2nd grade
3rd grade
4th grade
5th grade
6th grade
7th grade
8th grade
9th grade
10th grade
11th grade
Graduated from high school
1 year of college
2 years of college
3 years of college
Associate's Degree
Bachelor's Degree
Some graduate school
Master's Degree
Doctorate Degree
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16.
Which of the following categories best describes your employment status?
(Required.)
Employed, working full-time
Employed, working part-time
Not employed, looking for work
Not employed, NOT looking for work
Retired
Disabled, not able to work
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17.
Please describe your past or present job.
(Required.)
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18.
What is your total household income?
(Required.)
Less than $20,000
$20,000 to $29,999
$30,000 to $49,999
$50,000 to $59,999
$60,000 to $69,999
$70,000 to $79,999
$80,000 to $89,999
$90,000 to $99,999
$100,000 or more
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19.
Have you attended any training, education, lectures, seminars, or courses in any of the following areas? (Please check all that apply)
(Required.)
Accounting
Brain Injuries
Business
Business Law
Computers
Contracts/Negotiations
Finance
Insurance
Law
Manufacturing
Medicine
Psychology
Trucking Regulations
Work Safety
None of the above
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20.
What's your primary source of news?
(Required.)
Internet
Print/Newspaper
Radio
Social Media
Television
Other (please specify)
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21.
What is your favorite news program?
(Required.)
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22.
Economically, I consider myself:
(Required.)
Very Conservative
Consevative
Moderate
Liberal
Very Liberal
Not Sure
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23.
Socially, I consider myself:
(Required.)
Very Conservative
Conservative
Moderate
Liberal
Very Liberal
Not Sure
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24.
Are you a registered voter?
(Required.)
Yes
No
Unsure / Don’t know
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25.
What is your political preference/affiliation?
(Required.)
Republican
Democrat
Independent
Other (please specify)
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26.
In the last election how did you vote?
(Required.)
Democrat
Republican
Other (please specify)
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27.
What is your opinion on the political system?
(Required.)
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28.
How important is religion to you?
(Required.)
Extremely important
Very important
Somewhat important
Not so important
Not at all important
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29.
Do you have law enforcement experience?
(Required.)
Yes
No
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30.
Do you have any family members with experience in law enforcement?
(Required.)
Yes
No
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31.
What is your overall opinion of law enforcement?
(Required.)
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32.
Have you ever served in the military?
(Required.)
Yes
No
33.
If yes, please provide the branch, number of years and highest rank achieved.
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34.
If a friend or family member says something you disagree with, how likely are you to provide your opinion?
(Required.)
Very likely
Likely
Neither likely nor unlikely
Unlikely
Very unlikely
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35.
What is your opinion on the legal system?
(Required.)
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36.
Do you consider yourself to be opinionated?
(Required.)
Yes
No
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37.
What are your top 3 favorite hobbies?
(Required.)
Favorite hobby #1
Favorite hobby #2
Favorite hobby #3
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38.
Have you received COVID-19 vaccination?
(Required.)
Yes
No
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39.
What is your current marital status?
(Required.)
Single
Married
Divorced
Prefer Not to Say
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40.
How many people reside in your household?
(Required.)
1 (Just you)
2
3
4
5
6 or more
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41.
Have you ever participated in a focus group before and if so, what type of focus group was it?
(Required.)
Product testing
Legal (Mock jury)
Advertising
Market research
Educational
Other (please specify)
I have not previously participated in a focus group
Current Progress,
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