Online Market Research Pre-Screener Form

STUDY DETAILS:
2 hour online focus groups for COLORADO RESIDENTS 
*Proof of residency may be requested*

DATES:
-Focus groups are taking place on either:
Tuesday, August 30th at  either 4-6pm MDT or 6:30-8:30pm MDT
Thursday, September 8th at either 4-6pm MDT or 6:30-8:30pm MDT
Monday, September 12th at either4-6pm MDT or 6:30-8:30pm MDT

INCENTIVE
$150 paid via digital gift card for full participation

*Please make sure all the answers you provide below are answered with only the most honest and accurate information. We pride ourselves in providing our clients with he best possible respondents for our project. If we find out the information you have provided is not accurate, you will not be asked to participate in future research studies with Honest Recruiting Services, LLC.
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Email *
Name (first and last): *
Age: *
Gender *
Phone Number: *
Which of the following best describes your Ethnicity? Select all that apply *
Required
What is your Highest Level of Education? *
Which of the Following Best Represents your Household Income (Please include ALL working members of your household)? *
What STATE do you live in? *
What CITY do you live in? *
What COUNTY do you live in?
What is your Zip code?

How would you describe the area where you live? Do you live in:

 *
Are you currently…? *
Required
Are you currently employed? If so, what is your current job title? *
What industry do you currently work in?
So that we can be sure to represent a wide variety of industries or professions, please tell me if you or any of your household works in any of the following types of industries?   *
Required
When was the last time that you participated in a focus group, interview, or online panel for the purpose of market research? *
What were the topics of all the group discussions, interviews and online panels that you participated in for the purpose of market research?
Which of the following best describes your marital status? *

Do you have a child at home under the age of 18? 

 *

Are you registered to vote at your current address? 

 *

Generally speaking, do you think of yourself as a Democrat, a Republican, or an Independent? 

 *
Which of the following statements comes closest to your own point of view? 
 *

 Here are some more topics that have been in the news. For each one, please indicate whether you personally feel that Colorado state laws regarding that topic should be much more restrictive, somewhat more restrictive, kept the same, somewhat less restrictive, or much less restrictive. 

 *
1- Much more restrictive
2-Somewhat more restrictive
3-Kept the same
4-Somewhat less restrictive
5-Much less restrictive
Gun sales and ownership
Marijuana sales and use
Availability of abortion
Environmental protections
In your own words, can you please tell me what you see as the biggest challenge facing families in your community today? 
Do you currently have medical insurance coverage, or not?  [IF YES:] What kind of insurance coverage do you have?  
 *
What language do you speak at home? *
Are you able to speak/understand Spanish fluently? *

Do you currently own and/or use a personal computer (laptop or desktop) that has reliable high-speed access to the Internet (broadband, cable, satellite, 4G/5G cellular hotspot) and a webcam?

 *
The interview session will be conducted online via the Zoom platform. How comfortable would you be participating in this portion of our project? *

Could you participate in an online research discussion on your computer in a private place for two hours without being interrupted?

 *
How did you hear about this opportunity? *
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