SF Upcoming PAID study on People - July 2011

1. SF Upcoming PAID study on People - July 2011

Thank you for taking the time to answer these brief questions. As always, we appreciate your input as a valuable Plaza Research respondent. We have a new study on People that you may be interested in.

We are currently looking for people 16-80 years old for a 3-hour individual interview. You will receive a $90 honorarium for your participation.

IF you qualify based on the answers provided THEN you will receive a call back. However due to the popularity of our surveys and groups, we can't contact everyone.

Please note that all responses will be returned on a first come, first served basis until the studies are full.

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* 1. Contact Information

Name

Cell Phone

Home Phone

Work Phone

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* 2. Employment Information

Job Title

Company Name

Industry

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* 3. What is your highest level of education?

Attended 8th grade or less

Attending 9th-12th grade, without a high school diploma

Received High school diploma/GED

Received some college credit but no degree

Received Associate degree (AA, AS)

Received undergraduate degree (BA, BS, BFA, etc)

Received Graduate or Professional degree (MA/MS, JD, MD, PhD, EdD)

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* 4. What is your gender?

Male

Female

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* 5. In which age range do you fall?

Under 16

16-40

41-60

61-80

81+

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* 6. Do you have children under the age of 18?

Yes

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* 7. Have you been diagnosed with any of the following? Please check all that apply.

Intellectual Disability

Gifted and Talented

Attention Deficit/Hyperactivity Disorder (ADD/ADHD)

Learning Disability

Traumatic Brain Injury

Borderline Intellectual Functioning

Major Depression

Anxiety

None of the above

**IMPORTANT: PLEASE PUSH THE "DONE" BUTTON AT THE BOTTOM OF THIS SCREEN. YOUR ANSWERS WILL NOT BE SAVED WITHOUT DOING SO!**

Thank you for participating in our survey. IF you qualify based on the answers provided THEN you will receive a call back. However due to the popularity of our surveys and groups, we can't contact everyone. Please note that all responses will be returned on a first come, first served basis until the studies are full.

*****REFERRALS ARE GREATLY APPRECIATED!*****

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* 1. Contact Information

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* 2. Employment Information

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* 3. What is your highest level of education?

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* 4. What is your gender?

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* 5. In which age range do you fall?

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* 6. Do you have children under the age of 18?

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* 7. Have you been diagnosed with any of the following? Please check all that apply.

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* 8. ******FOR COMPANY USE ONLY****** (Please press next)

* 8. FOR COMPANY USE ONLY
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