FOCUS GROUP APPLICATION
Thank you for your interest in participating in our Focus Group. The pay is $75.00 plus a complimentary lunch. All backgrounds are encouraged to apply. More details will be emailed to you if you are chosen. Complete the following questions to apply:
LAST Name? *
Your answer
FIRST Name? *
Your answer
Phone Number
Your answer
E-Mail Address? *
Your answer
Gender? *
Age? *
Your answer
Race? *
Currently Employed? *
If yes, Position or Title
Your answer
City/Town you live in? *
Your answer
Political Affiliation? *
(Democrat, Republican, Other, etc.)
Your answer
Marital Status
Children?
Highest Grade in School? (ex. 11th grade, HS Grad, some college, masters)
Your answer
Ever been a party to a lawsuit, other than divorce?
If yes, what kind of lawsuit?
Your answer
Ever served on a jury?
What news program do you watch?
Your answer
Hobbies?
Your answer
Where did you hear about us?
Have you participated in one of our past focus groups? *
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