premiumsolutions
Job # 12-03-365
SCREENING QUESTIONNAIRE
Monday, March 26 – Richmond VA |
||
4:30 pm |
Group 1 |
|
6:30 pm |
Group 2 |
|
Monday, April 9 – Boston MA |
||
4:30 pm |
Group 1 |
|
Wednesday, April 11 – Portland OR |
||
4:30 pm |
Group 1 |
|
Monday, April 23 – Atlanta GA |
||
4:30 pm |
Group 1 |
|
6:30 pm |
Group 2 |
|
Tuesday, April 24 – St. Louis MO |
||
4:30 pm |
Group 1 |
|
6:30 pm |
Group 2 |
|
Respondent Name ____________________________________________________________________ |
Date Screened _______________________________ Interviewer ID __________________________ |
PER GROUP, RECRUIT 11 PARTICIPANTS FOR 8 TO SHOW.
PER GROUP, RECRUIT 5-6 MALES AND 5-6 FEMALES.
Record gender by observation:
Male
Female
Hello. My name is _____ and I'm calling from _____ a market research company, on behalf of the US Department of Transportation. We are in the process of setting up some focus groups and I'd like to ask you just a few short questions to see if you might be able to join us.
1. Are you or is any member of your family, a friend or a relative employed in any of the following
occupations or types of companies? READ LIST.
|
YES |
NO |
A marketing consultant |
|
|
A market research firm |
|
|
An advertising or promotions agency |
|
|
A TV or radio station |
|
|
A magazine or newspaper |
|
|
Public Transportation |
|
|
Government Regulatory Agency or Public Policy Group |
|
|
IF "YES" TO ANY OF THE ABOVE – TERMINATE.
2. In our discussion we would like to include a mix of people – some who have been to a panel
discussion in the past and some who have not participated in a panel discussion before. Have you ever participated in a focus group, a panel discussion or an individual interview conducted by a market research company?
YES How long ago was that? ______________________________________
Do you recall the subject? ____________________________________
NO
DO NOT RECRUIT ANYONE WHO HAS PARTICIPATED IN A STUDY IN THE PAST 6 MONTHS.
3. May I ask your age? ____________________
A. |
|
18-20 |
B. |
|
21-23 |
C. |
|
24-26 |
D. |
|
27-34 |
E. |
|
35-44 |
F. |
|
45-54 |
G. |
|
55-61 |
RICHMOND, ATLANTA & ST. LOUIS
GROUP 1
ALL PARTICIPANTS MUST BE BETWEEN THE AGES OF 18 - 26.
GROUP 2
ALL PARTICIPANTS MUST BE BETWEEN THE AGES OF 27 - 61.
ACROSS THE GROUP BE SURE TO INCLUDE THE FOLLOWING:
2-3 PARTICIPANTS AGES 27-34
2-3 PARTICIPANTS AGES 35-44
2-3 PARTICIPANTS AGES 45-54
2-3 PARTICIPANTS AGES 55-61
BOSTON & PORTLAND
GROUP 1
ALL PARTICIPANTS MUST BE BETWEEN THE AGES OF 18 - 26.
4. What is your current marital status? Are you … READ LIST.
A. |
|
Single, Never Married |
B. |
|
Married |
C. |
|
Living with Significant Other |
D. |
|
Separated, Divorced, Widowed |
5. Besides yourself who is living in your household? CHECK ALL THAT APPLY.
A. |
|
Spouse/Partner |
B. |
|
Parent(s) |
C. |
|
Siblings |
D. |
|
Child(ren) |
E. |
|
Roommate(s) |
F. |
|
Live alone |
6a. Do you currently have a drivers license?
A. |
|
YES |
B. |
|
NO |
6b. IF AGES 18-26, ASK: Prior to having a “full” drivers license, did you have a graduated drivers
license, that is a license with restrictions at younger ages?
A. |
|
YES |
B. |
|
NO |
GROUP 1
INCLUDE SOME PARTICIPANTS WHO HAVE HAD A RESTRICTED OR GRADUATED DRIVERS LICENSE.
6c. Do you, yourself, currently own a car?
A. |
|
YES |
B. |
|
NO – Do you have access to a car?
YES NO |
7a. Have you used public transportation within the past month?
A. |
|
YES |
B. |
|
NO |
PER GROUP, TO THE DEGREE POSSIBLE, INCLUDE SOME PARTICIPANTS WHO HAVE USED PUBLIC TRANSPORTATION WITHIN THE PAST MONTH.
IF “YES” IN Q.7A, ASK 7B:
7b. Do you use public transportation … READ LIST.
A. |
|
primarily to travel to/from work or school |
B. |
|
primarily for personal use |
C. |
|
for both work or school and personal use |
8a. What is the last level of education that you completed? READ LIST.
A. |
|
Did not complete high school – TERMINATE |
B. |
|
High school graduate |
C. |
|
Some college, did not complete – ASK Q.8B |
D. |
|
College graduate |
E. |
|
Some post graduate school, did not graduate – ASK Q.8B |
F. |
|
Post graduate degree |
8b. Are you currently enrolled in a college or post college degree program?
|
YES – Is that … |
full time |
|
NO |
part time |
ALL PARTICIPANTS MUST HAVE GRADUATED HIGH SCHOOL (B).
PER GROUP, INCLUDE A MIX OF EDUCATION.
GROUP 1
ACROSS THE GROUP, INCLUDE SOME WHO ARE CURRENTLY ENROLLED IN A COLLEGE OR POST COLLEGE DEGREE PROGRAM.
8c. IF CURRENTLY ENROLLED IN A COLLEGE OR GRADUATE DEGREE PROGRAM, ASK:
Do you live… READ LIST.
A. |
|
on campus – TERMINATE |
B. |
|
off campus, with or without roommates |
C. |
|
with parents |
DO NOT RECRUIT COLLEGE OR GRADUATE STUDENTS WHO LIVE ON CAMPUS
9. Are you currently employed?
|
YES – Is that … |
full time |
|
NO |
part time |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
IF APPLICABLE, ASK SPOUSE/SIGNIFICANT OTHER'S OCCUPATION.
Name of Company: ______________________________________________ |
|
Type of Business: _______________________________________________ |
|
Job Title/Function: _______________________________________________ |
RECRUIT A REPRESENTATION OF “BROAD MIDDLE CLASS” OCCUPATIONS
10. Which of the following best represents your total annual household income before taxes?
READ LIST.
A. |
|
Under $25,000 |
B. |
|
$25,000 but less than $30,000 |
C. |
|
$30,000 but less than $40,000 |
D. |
|
$40,000 but less than $50,000 |
E. |
|
$50,000 but less than $60,000 |
F. |
|
$60,000 but less than $75,000 |
G. |
|
$75,000 or more |
PER GROUP, RECRUIT A RANGE OF HOUSEHOLD INCOMES.
11. We are interested in speaking with people of varying ethnic backgrounds.
Are you … READ LIST.
Of Hispanic or Latino origin?
|
YES |
|
NO |
A. |
|
White |
B. |
|
Black or African American |
C. |
|
Asian |
D. |
|
Native Hawaiian or other Pacific Islander |
E. |
|
American Indian or Alaska Native |
PER GROUP, RECRUIT A RANGE OF ETHNICITIES.
12. I'd like to invite you to participate in a discussion that we will be conducting at _____. This discussion will take about 90 MINUTES of your time. To show our appreciation, we'll offer you $_____ for your help. Are you interested in participating?
A. |
|
YES – CONTINUE WITH DATE, TIME, LOCATION, ETC. |
B. |
|
NO |
FINAL Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | SCREENING QUESTIONNAIRE |
Author | David |
File Modified | 0000-00-00 |
File Created | 2021-01-31 |