Sample screener

I’m contacting you with a short questionnaire to verify your eligibility for an upcoming customer interview. This interview is an opportunity to provide feedback on something my startup is currently working on. This interview will help us better understand your needs in order to incorporate them into our product.

We’re currently scheduling participants for interviews that takes place Nov 29. Interviews will be held over a Google Hangout. If you’re interested in participating, please complete the questionnaire below. If you're selected, we’ll then be in touch directly to discuss details and set your appointment time.

Details of the study:
- The duration of the interview is 45 minutes
- You’ll receive €50 as a token of our appreciation *

To participate you will need to:
- Be at least 18 years old
- Sign a Non-Disclosure Agreement
- Allow us to video or audio record the session

* Please note that you won’t be compensated for responding to this questionnaire; you’ll receive a gratuity only if you actually attend the interview.

Thank you for your time.

Hannes Cloze
Fundrrr, Co-founder

Mark ALL time slots for which we could schedule an appointment with you.
First and last name:
Your answer
Best email address to reach you:
Your answer
Best phone number to reach you:
Your answer
If you're currently working, what's your occupation?
If you're a student, please also include what you're studying.
Your answer
Where do you live?
Your answer
Which of the following do you use as your primary, personal mobile phone?
How often do you post something on the following websites?
Once a month or less
Less than once a week
Several times per week
At least once a day
Google Plus
In the past month, what did you want to learn?
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