SCREENING QUESTIONNAIRE
Hello, my name is (INTERVIEWER’S NAME) from (RESEARCH COMPANY). We are conducting a short survey and would like to ask you some questions.
Are you a senior in high school?
[ ] Yes ------ CONTINUE
[ ] No ------ THANK AND TERMINATE
What do you plan to do after high school?
[ ] Go to 4-year college/university ---------- |
[ ] Go to junior/community college |
[ ] Work/get a job |
[ ] Go to vocational school/job training |-- RECRUIT A MIX
[ ] Travel |
[ ] Join the military/military service |
[ ] Not sure/Nothing---------------------------- |
Thinking in terms of your grades, where would you put yourself as compared to other seniors in your school? Would you say that you are in the top 10%, the top 25%, top half or bottom half of your class?
[ ] Top 10% -------------------- |
[ ] Top 25% |
[ ] Top half | -- RECRUIT A MIX
[ ] Bottom half |
[ ] Don’t know/refused ----- |
Are you of Latino or Hispanic origin?
[ ] Yes |
[ ] No | -- RECRUIT A MIX
Continued on next page.
Which of the following do you consider yourself to be? Choose one or more. READ LIST
[ ] Asian --------------------------- |
[ ] White |
[ ] Black or African American |--- RECRUIT A MIX
[ ] Native Hawaiian or other Pacific Islander |
[ ] American Indian or Alaskan Native |
[ ] Some other race or ethnicity ---------------- |
RECORD GENDER
[ ] Male ----------------- | --- RECRUIT A MIX
[ ] Female --------------- |
Does anyone in your family work READ LIST:
[ ] in marketing or marketing research
[ ] in advertising or public relations
[ ] as a teacher or in education
THANK AND TERMINATE FOR ANY OF THE ABOVE
In the past 12 months, have you participated in a market research group discussion?
[ ] Yes -- THANK AND TERMINATE
[ ] No -- CONTINUE
We would like to invite you to a group discussion. The discussion will last approximately 1 ½ to 2 hours and will be held at (LOCATION) on (DATE) at (TIME). Your opinions are very important to us and to compensate you for your time, we will pay you $75. Are you able to join us?
Name: ______________________ [ ] 6:00 pm
Telephone: ___________________ [ ] 8:00 pm
| File Type | application/msword |
| File Title | SCREENING QUESTIONNAIRE |
| Author | Maria Ivancin |
| Last Modified By | DoED User |
| File Modified | 2007-12-11 |
| File Created | 2007-12-11 |