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Discussion Group Questionnaire 2021
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* Indicates required question
Do you have Venmo to use to receive payment for focus group?
*
Yes
No
Full Name
*
Your answer
Cell Phone / Home Phone
*
Your answer
Email Address
*
Your answer
Gender
*
Male
Female
Age
*
Your answer
Race
*
African American
Hispanic
White
Other
Political Affiliation
*
Republican
Democrat
Tea Party
Other
City you live in
*
Your answer
Marital Status
*
Married
Single
Live with significant other
Children
*
Your answer
Education
*
High School Diploma
Some College
Associates Degree
Bachelors Degree
Masters Degree or Higher
Required
Position / title at work
Your answer
Household Income
*
0-$30,000
$30,000 - $75,000
$75,000-$125,000
$125,000 and over
Have you ever been a Party to a lawsuit, including a Divorce
*
Yes
No
Ever served on a jury
*
Yes
No
Religion
*
Your answer
Have you ever participated in a legally related focus group? i.e. Mock jury
*
Your answer
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