Participant Survey

Please fill out the following survey to join R5's respondent database. We will contact you to participate in paid upcoming studies.

Thank You.

Name First Last
Phone - (###) - ### ####
Email
Date of Birth / MM / DD YYYY
Including yourself, how many persons are in your household?
Which of the following best describes your marital status: Married Living with a partner Divorced/Widowed/Separated Single
Do you have children?
If so, How Many?
What are their ages and genders?
Have you participated in a market research group before?
If yes, when was it and what was the topic?
Which of the following best describes your ethnicity? African American Caucasian Hispanic/Latino Asian Native American Other
If Other:

What best describes your ethnicity?
What is your country of origin?
What Languages do you speak at home?
What is the highest level of education you have achieved?
Which of the following best describes your current employment status? Full Time Part Time Self Employed / Business Owner Homemaker Retired College Student Unemployed
If employed, what is your occupation?

If employed, what best describes your current occupation.
What is your current household income level? Less than $25,999 $26,000-$40,999 $41,000-$55,999 $56,000-$70,999 $71,000-$100,999 $101k +
What city or neighborhood do you reside in?
What are some of your hobbies and interests?
Do you recycle?
What 3 words do you feel best describe you?
What websites do you visit most often?
Name some products and brands for yourself, household, etc. that you feel passionate about.
If you could take a dream vacation to anywhere in the world, where would you go and why?
How did you hear about R5 Research?