October/November
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Email *

Parents Email
Parents First Name *
Parents Last Name *
Parents Age *
Parents Phone Number *
Gender *
Ethnicity *
What CITY do you live in *
What COUNTY do you live in *
What STATE do you live in (ex- CA, NY, TX etc.) *
What is your Zip Code *
What region do you live in? *
What area do you live in? *
Highest Level of Education *
Employment Status *
What is your current occupation? (please list previous if unemployed, homemaker or retired) *
What industry do you work in? (please list previous if unemployed, homemaker or retired) *
Annual *Household* income (Everyone working adult in your home combined) *
Marital Status *
If you have children, how old are they? *
Required
Do you have children between 11-17? *
If you have more than one child between the age of 11-17; Please fill this form out multiple times. Going forward - Please only reference ONE CHILD.
What is your child's first name? *
How old is your child? *
What kind of phone does your child have?  *
Are you (Parent) giving permission for your child to upload an app to their phone, to participate in this study? *
Are you or is any member of your household currently employed by, previously employed by, or retired from any of the following types of companies *
Required
Payment for participation will be paid by email with a Visa Gift Card (Unless otherwise stated) Payment can take up to 3-4 weeks to receive after the study is completed. Are you ok with this? *
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