Attachment R - Final – 2010 AQE Focus Group PARTICIPANT SCREENERS – revised 12.27.2010
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Hello, my name is (insert name) and I work for a research firm called JBS/Aguirre Division. I am calling to talk with you about the opportunity participate in a focus group that could help improve the U.S. Census forms. We are recruiting participants from a variety of ethnic groups, ages and educational backgrounds. If you qualify and take part in our focus group you will be paid $75.00 for approximately two hours of your time. Can you take a few minutes to answer a few questions to determine whether you qualify to take part? (if YES, continue, if NO, thank the respondent and hang up/or thank them and politely end conversation)
Note gender: □ female □ male
Please answer the following questions to the best of your ability.
2a. Are you of Hispanic/Latino origin? □ Yes [if YES, ask 2b.] □ No [If NO, skip to 3a.]
2b. Do you speak Spanish? □ Yes [if YES, ask 2c.] □ No [If NO, skip to 3a.]
2c. Language Dominance- if respondent is Spanish Speaker: Do you prefer to complete forms in English or Spanish? □ English □ Spanish
3a. What is your race or origin? ________________________________________________________
[RECRUITER: IF RESPONDENT STATES “Mixed, Biracial, Multiracial”, ASK]
Please describe: ________________________________________________________________
3b. Are you any other race or origin?_________________________________________________
3c. What are your mother and father’s races or origins?
Mother_____________________________
Father______________________________
4a. In what city/country were you born? ____________________________________________
4b. If you were born outside the United States, how many years have you lived in the U.S.? _______________ years
4c. Were your parents immigrants to the United States?
□ Yes [if YES, ask 4d.] □ No [If NO, skip to 4e.]
4d. Where were your parents born?
Mother_____________________________
Father______________________________
4e. Were your grandparents immigrants to the United States?
□ Yes [if YES, ask 4f.] □ No [If NO, skip to 5.]
4f. Where were your grandparents born?
Grandmother_____________________________
Grandfather______________________________
[RECRUITER: BASED ON ABOVE RESPONSES, IF RESPONDENT IS APPROPRIATE FOR THE GROUP(S) FOR WHICH YOU ARE RECRUITING, CONTINUE]
5. What is your age: _________ years old
Highest level of education achieved:
□ Primary school □ Middle school □ Secondary school □ Some college
□ In college □ AA degree □ Undergraduate degree □ Graduate degree
7a. How many people live in your household? _______ # children?_________ # adults? _______
[RECRUITER: IF YOU ARE RECRUITING FOR MIXED, BIRACIAL, MULTIRACIAL ASK QUESTION 7b. BELOW.]
7b. If they report children in the household in question 7: Do the children have parents of different races? □ Yes [if YES, ask 7c.] □ No [if NO, skip to 8.]
7c. Could you please describe the races of each child’s mother, and father?
Mother:
_________________________________________
Father:
__________________________________________
7d. And what about the ages of those children?
(1)_____ (2) ______ (3) _____ (4) _____ (5) ______
8a.Have you ever participated in a focus group? □ Yes [if YES, ask 8b.] □ No [if NO, skip to 9.]
8b. How long ago or when was the last time you participated in a focus group?
□ Less than 6 months ago
□ More than 6 months, but less than a year ago
□ Over a year ago
8c. About how many focus groups have you participated in? _________
We are configuring the focus groups in the next week, and will conduct them next month. if you are selected what is the best way to reach you so we can confirm that you can come?
Name: __________________________________________________________________
Email: __________________________________________________________________
Phone #1 _____________________________ Phone #2__________________________
Thank you so very much!
[Note 2: There may be times where forms can be distributed at meetings after JBS recruiter has introduced and described the project. Respondents will be given the following version of the screener form to be collected by JBS/Aguirre staff at the meeting or event. It is SELF-ADMINISTERED. Recruiter should note time and date; plus the meeting location and type]
JBS/Aguirre International is a research firm and we are recruiting participants from a variety of ethnic groups, ages and income ranges to participate in focus groups that would help improve the US Census. If you are chosen and take part in our focus group you will be paid $75.00 for approximately two hours of your time. The information we are requesting is only for the purpose of getting diversity in our focus groups and will not be shared with others with you name. Please take a few minutes to answer a few questions to determine whether you qualify to take part.
Name: __________________________________________________________________________
What is your Gender: □ female □ male
Please answer the following questions to the best of your ability.
2a. Are you of Hispanic/Latino origin? □ Yes [if YES, go to 2b.] □ No [If NO, skip to 3a.]
2b. Do you speak Spanish? □ Yes [if YES, go to 2c.] □ No [If NO, skip to 3a.]
2c. Language Dominance- [SPANISH SPEAKER RESPONDENTS]: Do you prefer to complete forms in English or Spanish? □ English □ Spanish
3a. What is your race(s) or origin(s) ___________________________________________________
3b. Are you any other race or origin? ______________________________________________
3c. What are your mother and father’s races or origins?
Mother_____________________________
Father______________________________
4a. In what city/country were you born? ____________________________________________
4b. If you were born outside the United States, how many years have you lived in the U.S.? _______________ years
4c. Were your parents immigrants to the United States?
□ Yes [if YES, go to 4d.] □ No [If NO, skip to 4e.]
4d. Where were your parents born?
Mother_____________________________
Father______________________________
4e. Were your grandparents immigrants to the United States?
□ Yes [if YES, go to 4f.] □ No [If NO, skip to 5.]
4f. Where were your grandparents born?
Grandmother_____________________________
Grandfather______________________________
5. What is your age?: _________ years old
Highest level of education achieved:
□ Primary school □ Middle school □ Secondary school □ Some college
□ In college □ AA degree □ Undergraduate degree □ Graduate degree
7a. How many people live in your household? _______ # children?_________ # adults? _______
[RESPONDENT: IF YOU ARE MIXED, BIRACIAL, MULTIRACIAL PLEASE GO TO QUESTION 7b. BELOW; IF YOU ARE NOT MIXED/BIRACIAL/MULTIRACIAL, PLEASE GO TO QUESTION 8a.]
7b. If you report children in the household in Question 7: Do the children have parents of different races?
□ Yes [if YES, go to 7c.] □ No [if NO, skip to 8.]
7c. Could you please describe the races of each child’s mother and father?
Mother:
_________________________________________
Father:
__________________________________________
7d. And what about the ages of those children ?
(1)_____ (2) ______ (3) _____ (4) _____ (5) ______
8a. Have you ever participated in a focus group?
□ Yes [if YES, go to 8b.] □ No [if NO, skip to 9.]
8b. How long ago / when was the last time you participated in a focus group?
□ Less than 6 months ago
□ More than 6 months, but less than a year ago
□ Over a year ago
8c. About how many focus groups have you participated in? _________
We are configuring the focus groups in the next week, and will conduct them in several weeks. If you are selected what is the best way to reach you so we can confirm that you can come?
Email: __________________________________________________________________
Phone #1 :_____________________________ Phone #2:__________________________
Thank you so very much!
Attachment R – 2010 AQE Focus Group Recruitment Screener
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | csum |
| File Modified | 0000-00-00 |
| File Created | 2021-02-02 |