Research Application/Pre-survey

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Please complete this application form if you are interested in participating in Wall Street Juniors behavioral economics research study. To be considered for free or discounted services complete this application. Once you complete the form, click the "submit" button at the bottom.

Email *

Name (First, Last) *

Phone Number (000-123-4567) *

Date of Birth (MM/DD/YYYY) *

YYYY

Gender

Female

Male

Prefer not to say

Clear selection

Location (City, State) *

Education *

High-school Diploma

Some College

College Degree

Degree/Certification (If applicable)

Are you currently employed? *

Yes

Required

If so, where?

Employment history: (Please list any employment in the last 4 years.) *

Have you been convicted or plead guilty to a crime? *

Yes

Required

Have you been convicted or plead guilty to a crime? If so. What crime? Was it a misdemeanor or felony? What's the nature of the crime? How long ago (or not so long ago)? *

Have you recently been (last 12 months) on welfare or another form of public assistance? *

Yes

Availability *

Morning

Afternoons

Evenings

N/A (Not available)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Rate your financial behaviors on a scale from 1(never) to a 5(always). *

1: Never

2: Rarely

3: Sometimes

4: Usually

5: Always

I keep track of my expenses on a regular basis.

I put money aside for saving, future purchases, or emergencies.

I pay my credit card bills on time each month and am almost never late.

I prepare a budget every month.

I make goals about how to spend money and I discuss them with my family.

I shop or buy things on sale.

I have emergency funds for any financial situation.

50% of more of my monthly supplement income is provided by federal government based assistance

I help individuals in my community.

I clean up trash in my community.

I spend time on a monthly basis completing up to 1 hour of community service.

I socialize with individuals in my community once a month.

1: Never

2: Rarely

3: Sometimes

4: Usually

5: Always

I keep track of my expenses on a regular basis.

I put money aside for saving, future purchases, or emergencies.

I pay my credit card bills on time each month and am almost never late.

I prepare a budget every month.

I make goals about how to spend money and I discuss them with my family.

I shop or buy things on sale.

I have emergency funds for any financial situation.

50% of more of my monthly supplement income is provided by federal government based assistance

I help individuals in my community.

I clean up trash in my community.

I spend time on a monthly basis completing up to 1 hour of community service.

I socialize with individuals in my community once a month.

Program Preference *select all that may apply *

Real Estate

Stock Market

Vending Operations

Retail

T Shirt Business

Food Service

Affiliate Marketing

Social Media Management

Virtual Assistance

Lash Technician

E-course Development

Consulting

Branding

Graphic Design

Dropshipping

Publishing (e-books/books)

Podcast

Bartending

Event Planning

Cleaning Service

Childcare

Required

I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.” *

I attest to this statement as true.

I do not attest to this statement as true.

Required

A copy of your responses will be emailed to the address you provided.

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