FocusJr

Name

Telephone number

Address

City

State

Zip code

Email address

What is your job title or position?

Just to check, are you the female or male head of the household?

Yes
No

Are you:

Male
Female

What is your exact age?

What is the name, age and gender of each person living in your household?

Which of the following statements best describes you.

Me/my significant other is currently pregnant with our first child
Me/my significant other is currently pregnant, but it is not our first child
Me/my significant other have a newborn under six months of age that is our first child
Me/my significant other have a newborn under six months of age that is not our first child
Me/my significant other are not currently pregnant and do not have a newborn under six months of age

How many weeks along are you/significant other in your pregnancy?

0-12 weeks
13-17 weeks
18-21 weeks
22-25 weeks
26-27 weeks
31-34 weeks
35-38 weeks
39-42 weeks

Have you created a baby registry at any retailer online or at a store location?

Yes
No

And where did you register for your baby? Would that be…?

Baby Depot
Babies R Us
Buy Buy Baby
Target
Walmart
Online
Other

Which of the following statements best describes your level of expertise using personal computers?

I would consider myself a beginner and am gradually becoming comfortable using my computer
I am comfortable using a few applications and doing basic program installations
I would consider myself an advanced user but still need some technical support for problems that arise
I would consider myself a very advanced PC user. I can solve most complex problems that arise.
I would consider myself a very advanced PC user. I can solve most of my own PC issues and other people come to me for help with their PC problems

Have you, yourself participated in a marketing research study in the past three months, or not?

Yes
No

Are you currently scheduled to participate in any marketing research studies in the near future.

Yes
No

What is your current employment status? Are you….?

A full-time employee
Working part-time
Not currently working/ looking for work
A stay-at-home mom or dad

What is your marital status? Are you

Married
Single
Widowed
Divorced
Separated
Living with significant other as married

Where are all the working members of your household, including yourself, employed?

Are you or is any member of your household currently employed by, previously employed by, or retired from any of the following types of companies?

An advertising agency or market research firm, marketing firm or Marketing department in your own firm
A public relations company
By the news media, such as television, radio or a newspaper
As a financial consultant, bank manager, or employed by an investment or brokerage firm
A multi-level marketing company like Amway, Mary Kay or Avon
As the manager of a grocery store, supermarket, convenience store, discount store or mass Merchandise store like Wal-Mart or Target
As an employee of a company that manufactures, distributes or sells household or baby products

Please tell me what level of education have you, yourself, have completed. Would that be…

Attended high school, but did not graduate
High school graduate
Completed some college
Graduate of a 2 - year college
Graduate of a 4 - year college
Post graduate/study/degree
Other

Which of the following ranges includes your total yearly household income?

Less than $80,000
$80,000 - $89,999
$90,000 - $99,999
$100,000 - $109,999
$110,000 or more

Which of the following best describes your ethnic background?

African American
Asian
Hispanic/Latino
Native American
Bi-racial
Caucasian

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