Screening Questionnaire

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.

1. Are you a senior in high school?

[ ] Yes ------ CONTINUE

[ ] No ------ THANK AND TERMINATE

2. 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---------------------------- |

3. 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 ----- |

4. Are you of Latino or Hispanic origin?

[ ] Yes |

[ ] No | -- RECRUIT A MIX

Continued on next page.

5. 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 |

6. RECORD GENDER

[ ] Male ----------------- | --- RECRUIT A MIX

[ ] Female --------------- |

7. 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

8. 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