Real Survey Invitation email

Survey Sample


"This is a survey sample. The Submit and Reset buttons will not work ."

How much time would you take to fill out a survey like this one? 6 to 10 minutes at the most?
Well, $25.00 USD in your pocket. It's that simple!

How many of these can you do per day?

SURVEY SAMPLE:

* denotes required field


THE BASICS

1. What is your name?*
 

First:
Last:
Phone #:


2. Your primary e-mail address:* (Please enter carefully)


3. The city/town you live in is…


4. The state you live in is…


5. Your gender:*
Male
Female

6. What is your age?*
Age 17 or less (We are sorry, you do not qualify.)
18 to 21
22 to 25
26 to 34
35 to 44
45 to 54
55 to 65
66 or older



JUST ABOUT KIDS

7. How many children live in your household with you, age 17 or less?
1
2
3
4
5 or more
None / No children (PLEASE SKIP TO QUESTION # 13)

8. How many children do you have in each of the following age categories:

One year old or less 1    2    3    4 or more
Age 2 to 4 1    2    3    4 or more
5 to 7 1    2    3    4 or more
8 to 12 1    2    3    4 or more
13 to 17 1    2    3    4 or more
18 to 21 1    2    3    4 or more

 

Questions #9 through #12 are for female parents of children age 2 - 7 only. Otherwise please skip to question #13.

To what degree do you agree or disagree with the following statements:

9. When shopping for my child, I shop at different stores for sleepwear and playwear.
Strongly Disagree
Somewhat Disagree
Neither Agree nor Disagree
Somewhat Agree
Strongly Agree

10. When shopping for my child, one of the most important things is that the clothes have cute designs.
Strongly Disagree
Somewhat Disagree
Neither Agree nor Disagree
Somewhat Agree
Strongly Agree

11. When shopping for my child, I prefer to go to stores that specialize in children’s clothing.
Strongly Disagree
Somewhat Disagree
Neither Agree nor Disagree
Somewhat Agree
Strongly Agree

12. When shopping for my child, I prefer to go to a store that has a wide variety of brands in children’s clothes.
Strongly Disagree
Somewhat Disagree
Neither Agree nor Disagree
Somewhat Agree
Strongly Agree



ACTIVITIES AND SHOPPING

13. Which of the following products have you used in the past week? (PLEASE CHECK ALL THAT APPLY.)
Soda or other carbonated drinks
Sliced deli meats
Salted snacks (such as potato chips or salted nuts)
Tobacco cigarettes
Bottled water

14. Which of the following activities do you, yourself, actively engage in? (PLEASE CHECK ALL THAT APPLY.)
Regular exercise
Computer/video games
Go to live theatre/plays
Attend sporting events
Visit art galleries/museums
Personal investing other than employment 401Ks
Visit night clubs/bars
Play board games with friends/family
Frequently travel out of state for pleasure
Go to the library
Do-it-yourself home improvement re-decorating (painting, refinishing)
Do-it-yourself home improvement re-modeling (installing new floors, cabinets)
Gardening
Boating
Hunting

15. When it comes to making decisions about products and services for the household costing $500 or more, would you say you are most likely to have…
the most influence
equal influence with one or more
a little influence
no influence



A FEW LAST QUESTIONS

16. Which of the following best describes your occupation?
Executive/managerial
Salesperson/buyer
Professional/technical
Clerical/administrative
Warehouse/trade/construction
Homemaker
Student
Not currently employed
Retired
Other

17. What was the last grade of school you completed?
Less than HS graduate
HS graduate
Some college
College graduate or more

18. Which of the following best describes your ethnic background?
Caucasian
African-American
Hispanic or Latino
Asian
Native American
Other


 

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