Are you available on March 2, 2024 or March 3, 2024, from 1:00 pm to 4:00 pm?
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Yes - Sign me up for March 2
Yes - Sign me up for March 3
No
Name
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First Name
Last Name
Phone
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(###)
###
####
Do you want to receive focus group updates by text message?
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If you choose yes, standard text message charges may apply.
City of Residence
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County of Residence
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Birthdate
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MM
DD
YYYY
Gender
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Male
Female
Race
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Caucasian (white)
Asian
African American
Hispanic
Native American Indian
Other
Marital Status
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Single/Never Married
Married
Separated
Divorced
Widow/Widower
Living with Partner
Other
Are You Currently a Student?
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No
Yes - Full Time
Yes - Part Time
Highest Level of Education
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Some High School
High School Diploma or GED
Some College
College Degree
Some Graduate School
Graduate Degree
Occupation
*
Employer
*
Length of Employment
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Less than 1 year
1-5 years
5-10 years
10 or more years
Spouse's Occupation (if applicable)
Income
*
$0 - $20,000
$20,001 - $40,000
$40,001 - $65,000
$65,001 - $85,000
over $85,000
Have You Ever Served on a Jury?
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Yes
No
Are You Currently Called for Jury Duty?
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Yes
No
Have You Ever Participated in a Focus Group?
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Yes
No
If Yes, Please Provide a Short Description About the Focus Group
Do You Know Someone Who Has Already Signed Up for this Focus Group?
Yes
No
If Yes, please provide the name of that person
How did you hear about this focus group?