Are you… [single-select]
- Female
- Male
- Prefer not to answer
What is your age range? [single-select]
- Under 18
- 18-24
- 25-34
- 35-44
- 45-54
- 55-64
- 65-74
- 75 or older
- Prefer not to answer
Sometimes we look for people who work in particular industries. Do you, or does anyone in your family work in the following industries? [multi-select]
- Advertising/Marketing [TERM]
- Entertainment
- Market Research [TERM]
- Online or Internet Commerce
- Discount or Department store
- Television / Radio / Cable
- None of the above [EXCLUSIVE]
In what state do you reside? [single-select]
- [list out states]
- I reside in a country other than the United States [TERM]
What is your ethnicity? [single-select or multi-select]
- Asian
- Native Hawaiian or other Pacific Islander
- Hispanic/Latino
- Black or African American
- Native American
- Caribbean Islander
- White/Caucasian
- Prefer not to identify
- Other (please specify) ____________________
*Quick note on the ethnicity question: If setting up census-based ethnicity quotas, it is preferable that the question is single-select with a separate question that asks if the respondent is Hispanic.
Which category best describes your total annual household income before taxes? [single-select]
- Less than $15,000
- $15,000 to $24,999
- $25,000 to $34,999
- $35,000 to $49,999
- $50,000 to $74,999
- $75,000 to $99,999
- $100,000 to $124,999
- $125,000 to $149,999
- $150,000 to $174,999
- $200,000 to $224,999
- $225,000 to $249,999
- $250,000 or more
- Prefer not to answer
Which of the following best describes your marital status? [single-select]
- Married/ Domestic Partner
- Widowed
- Divorced
- Separated
- Single/ Never Married
- Prefer not to answer
How many children (under 18) do you have living at home?
- None
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
- More than 10
- Prefer not to answer
Please indicate which of the following activities you’ve done on any of the electronic devices you own. [TERM if “None of these” or less than 4 answers are selected]
- “Liked” brands on social sites (e.g. Facebook, Twitter, etc.)
- Bought products from shopping apps
- Downloaded shopping apps to check out products and look for deals
- Received texts and messages from companies that have deals, coupons, and sale reminders
- Managed finances or bank accounts online or in an app
- Managed flight or travel reservations online or in an app
- Played games with others online or in an app
- Posted content on social networking sites (e.g. Facebook, Twitter, Instagram, Pinterest, etc.)
- Read or posted a blog
- Searched the internet for deals and coupons
- Searched the Internet for news and information
- Sent and/or received text messages
- Surfed the web on your smartphone
- Used an app or searched the internet while shopping in a physical store
- Watched online videos (e.g. YouTube)
- None of these
Sample Community Opt-In Text
In the Community Name, you will be part of a group of about X of our customers. Community members will learn from each other and provide feedback to Company that will guide the approach for engaging other member groups across the country.
We hope that you’ll be able to log in regularly to discuss topics related to INDUSTRY or INDUSTRY with your fellow community members and facilitators. For your time and participation, you will have a chance to [INCENTIVE PROGRAM]. You will also be able to opt out at any time.
Does this sound like a good fit for you and are you willing to become a member of the Community Name?
A) Yes
B) No (You will not become a member of the community) [TERM]