Focus Group Application

Participants wanted for our upcoming on-line Zoom Virtual Focus Group. Participants must have access to a desktop/laptop/iPad/tablet (not cell phone) with a camera and microphone, and a reliable internet connection. Participants must be in a private, quiet, and distraction free environment during the scheduled session.

Participants will be paid $60.00, which will be sent out by mail immediately following the Focus Group.

Please fill out the online application below and you will be notified in advance if you are approved to participate. Once approved, you will receive a link to the virtual Focus Group. Thanks!

Event Date

1st and 3rd Wednesdays Every Month, 2:00 PM to 5:00 PM

Name:

First

Middle

Last

Phone:

Area Code

-

Phone Number

E-mail:

Race:

Gender

Male

Female

Date of Birth:

Place of Birth

Marital Status

Married

Single

Divorced

Current Employer

Job Description

How long Employed there?

if self-employed, name of company & type of business

Location (City & State)

Highest grade in School

Total family income

$0-$41K

$41k-$75k

$75k-$100k

$100k+

Have you ever served in the U.S. Military?

Yes

No

Have you ever been convicted of a Felony?

Yes

No

Ever been a party to a lawsuit (other than a divorce)?

Yes

No

If YES, Please provide details

Have you ever served on a Jury?

Yes

No

If YES, Please provide details

Have you ever participated in a Focus Group before?

Yes

No

If YES, what kind of Focus Group?

Name of the last book you read?

What magazines do you like to read?

How many times a week do you watch the news?

What is your favorite movie genre?

Which newspaper(s) do you read?

What are your hobbies?

SubmitReset