Vaccines
This questionnaire is a pre-screener to seek eligibility for a market research project. You do NOT get compensated for filling out this form. If you pre-qualify, you will receive a text or email from a Recruiter to call our office.  

Parents of children 9-12yrs

Online Project Group via Desktop/Laptop with Webcam (NO CHROMEBOOK/TABLETS/PHONES)

Wednesday, June 8th at 9am ET  - Friday, June 30th by 12pm ET - project must be completed anytime between those dates - approximately 45mins, $50 if chosen.

Follow Up Webcam Group: 90 minutes: $150, if chosen (some selected for webcam group) If selected, you will be contacted by email with the details.

Webcam Groups: Thursday, July 6th  must join 15-mins early - please adjust for your specific time zone.

Group 1: 11am-12:30pm ET

Group 2: 1pm-2:30pm ET

Group 3: 3pm-4:30pm ET 

Compensation: $50-$200 (if chosen) for full-participation.
Incentives will be sent through Focus Group Wallet. Email will arrive within 2-3 weeks.
By filling out this form you are giving AO permission to email, text and/or call you
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Email *
Email * (if you have a Gmail account please enter that email address, preferred) *
The email below will be the Email you will be using for the project, if selected.
First Name *
Last Name *
Gender *
Your Exact Age *
What is your date of Birth? * *
MM
/
DD
/
YYYY
Age *
Cell Phone Number *
Enter phone number as 9991234567 (no dashes, spaces, etc.)
Cell Phone Carrier * *
Other Number (skip if you do not have another phone number)
Enter phone number as 9991234567 (no dashes, spaces, etc.)
Information from the US Census

White – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

Black or African American – A person having origins in any of the Black racial groups of Africa.

American Indian or Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.

Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Native Hawaiian or Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.

What do you consider to be your race or ethnicity  ? *
Select ALL that Apply, If Other, please specify
Required
Last Level of Education you Completed *
Household Income (This is not your Personal Income, but the Income of the Household Example: 4 People living in a household related/unrelated Person1: Student w/PT Job paid off the books earns $200week + receives $1,000 month from parents for rent = $22,400 ) Person2: Disability $200week=$10,400yr + Person3: FT delivery service Job paid off the books earns $200week =$10,400yr + Person4 PT Cook $200week=$10,400yr Total Household Income $52,600) *
Are you a  Student *
Employment Status *
If you are Retired, Student, Homemaker, etc AND work, please check off either full-time or part-time working
If you are self-employed, please check off either full-time or par-time working
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