School Kids and Teens Question Title * 1. MURRAY HILL CENTER A NATIONAL MARKET RESEARCH COMPANY HAS BEEN COMMISSIONED TO INTERVIEW PARTICIPANTS FOR AN UPCOMING PROJECT. THIS WILL BE A MULTI PHASE PROJECT THAT PAYS BETWEEN $150 AND $350. IF YOU ARE INTERESTED IN PARTICIPATING, PLEASE ANSWER ALL OF THE FOLLOWING QUESTIONS Name: Company: Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Country: Email Address: Phone Number: Question Title * 2. This project will include your child, and there will be an online diary assignment that lasts for 2 weeks. There will be a possibility that you and your child are chosen for an in person interview that will take place in your home. Are you willing to allow your child to participate alongside you in our research project? Yes No Question Title * 3. Do you currently have any children living at home with you? Yes No Question Title * 4. How many children do you currently have living at home with you full time, of whom you are the parent or legal guardian? None 1 2 3 4+ Question Title * 5. How many of these children are between the ages of 13 and 18? None 1 2 3 4+ Question Title * 6. Please tell me the name, age, school grade, and gender of each child between the ages of 13 and 18 who live with you full time?EXAMPLE: Amy, 14, 9th grade, Female Teen One Teen Two Teen Three Teen Four Question Title * 7. What is the name(s) of the high school(s) your children attend School 1 School 2 School 3 School 4 Question Title * 8. What type of school are your high school aged children enrolled in? Public school Charter school Private or Catholic school Home school Other (please specify) Question Title * 9. What zipcode is your teenage child's school? If you are not sure, please look it up, it may be different than your home address zipcode. If there are multiple high schools your children attend, please provide all the zipcodes, separated by commas Question Title * 10. Are you or any member of your household currently employed, or have you ever been employed, by any of the following types of companies? Advertising agency, public relations, or a media company Market research company or marketing dept. within a company News media, such as television, radio or newspaper IT (Information Technology) Local, State, or Federal Government User Experience or Product Testing K-12 Education Food Service Healthcare Bookstore or book publisher None of the above Question Title * 11. Are you or any member of your household currently a student in or graduate of any Information Technology (IT) or Human Computer Interaction (HCI) programs? Yes, my spouse and/or I have an IT degree Yes, my spouse and/or I have an HCI degree No, no one in my family has an IT / HCI degree Question Title * 12. When was the last time your child participated in a market research interview or focus group discussion? Never In the past 0 - 6 months In the past 6 - 12 months It has been over a year since my child has participated in a market research study Question Title * 13. In what country were you born? We will not share this info outside of the research parameters. US Mexico Canada Other (please specify) Question Title * 14. What is the highest level of education you have completed Some High School Graduated High School Some college Graduated College (undergraduate) Post Graduate Question Title * 15. Into which of the following categories does your total annual pre-tax household income fall? Less than $9,999 $10,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $60,000 $60,000 or more Question Title * 16. In order to make sure we have accurately represented all people, we are interested in your ethnic background. Which of the following categories best describes your ethnic background? Caucasian African American Hispanic/Latino Asian, Native American, Other Mixed race Question Title * 17. And which of the following categories best describes your child's ethnic background Caucasian African American Hispanic/Latino Asian, Native American, Other Mixed race Question Title * 18. In order to make sure we have accurately represented all people, we are also interested in how you describe the general location of your current residence. Would you consider your current location/town to be…? Urban Suburban Rural Question Title * 19. Please describe what type of student your high schoolers are. If there are more than one, please use their name and tell us about their academic standings. Are they self starters with studying, need some encouragement, or every night is struggle. Please tell us their estimated grade average as well ( A student, B student, etc) Teen One Teen Two Teen Three Teen four Question Title * 20. Are any of your teen children in an accelerated academic program in any of their classes Yes No Question Title * 21. If any of your high schoolers are in AP classes, please again tell us the child's name and which subjects they are enrolled in accelerated or AP classes Teen One Teen Two Teen Three Teen Four Question Title * 22. Which of the following options best describes your employment status? Full time Part time Temporarily employed or Seasonal employee Full time homemaker Student Disabled or Handicapped - not employed Retired Other (please specify) Question Title * 23. Which of the following bests describes your marital status? Single, never married Divorced Widowed Separated, not living in the same residence Married Question Title * 24. Once we receive your responses to this questionnaire, we will follow up with you to tell you which child might qualify for the project. At that time we will send you another online questionnaire similar to this one that is meant for your child to fill out themselves. If your family is chosen for this research project are you willing to help your teen fill out the above mentioned questionnaire as well as complete the online diary that last for 2 weeks, and requires them to answer a quick series of questions each day ( 10 -15 minutes per day) about their homework and test load for each day? Yes No Maybe, please give me a call and it explain more Done