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FOX - April 17 - NYC

Page One

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3. Were you born in America? *This question is required.
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6. What is your gender? *This question is required.
7. Have you ever participated in a Luntz Global / Word Doctors focus group before? *This question is required.
8. How interested would you say you are in politics and government policy? (0 indicates no interest at all, 5 indicates moderate interest, and 10 indicates very significant interest.) *This question is required.
9. From zero to seven, how many days a week do you watch the news on TV, listen to news on the radio, read a daily newspaper, or read news online? *This question is required.
10. How many times in the past two years or so have you either written, emailed, or called an elected official (local, state or national) about any issue, or attended a political rally of some kind? *This question is required.
11. When you think about the political and economic conditions in America, do you agree or disagree with the following statement: "I'm mad as hell and I'm not going to take it anymore." *This question is required.
12. Thinking of all the elections that you vote in, would you say that you generally vote for...? *This question is required.
13. Which of the following best describes your political ideology? *This question is required.
14. Which candidate did you vote for in the 2008 presidential election? *This question is required.
15. In the November 2010 election for UNITED STATES HOUSE OF REPRESENTATIVES, which party did you vote for? If you didn't vote in the election, just indicate. *This question is required.
16. In the November 2010 election for UNITED STATES SENATE, which party did you vote for? If you didn't vote in the election, just indicate. *This question is required.
17. In the November 2010 election for NEW YORK GOVERNOR, who did you vote for? If you didn't vote in the election, just indicate. *This question is required.
18. How likely are you to vote in the upcoming November 2012 Presidential election? *This question is required.
19. If the 2012 Presidential election was held today and you HAD TO CHOOSE, would you be more likely to vote for Barack Obama or the Republican presidential nominee, whoever that person might be? *This question is required.
20. Which of the following best describes your opinion of the "Tea Party Movement" in America? *This question is required.
21. What is your highest level of education? *This question is required.
22. What is your total yearly PERSONAL income? *This question is required.
23. Copy of What is your total yearly HOUSEHOLD income? *This question is required.
26. If you had to pick ONE of the following, which ONE best describes your ethnic/racial background? If other, please specify. *This question is required.
27. Are you willing and able to sit through a three hour dial session, without opportunity for a break? Please note that if you are on medication that requires you to use the restroom frequently, your answer should be "NO."
28. We are conducting what is called a focus group in which you will participate in a group discussion. You will be asked to discuss your opinions on issues relating to television and the internet. If you wear glasses or contacts, please wear your contacts or bring glasses with you. If you wear a hearing aid, please wear it for the session. You must be able to read, hear, and speak clearly and easily. There will be materials to read and comment on, as well as video presentation you must able to see, hear, and understand. Because this is a group discussion you will be required to voice your opinion and participate in conversations.

Will this be a problem for you? *This question is required.
29. By completing this questionnaire, you are agreeing to notify us of any current, short term circumstances which would prevent you from attending our focus group. That includes but is not limited to: responsibility to care for others, illness, personal health issues, and professional or personal scheduling conflicts. Are there any current circumstances which would prevent you from attending our focus group? *This question is required.
30. Would you like to receive future notices about Luntz Global focus groups and events? *This question is required.
31. I pledge that all answers provided to this questionnaire are true and correct. I agree that, as a condition of participation, I will not record, post, publish or publicly disseminate, either online or in print, any information about the contents and experience of this session. I understand that all information presented in the focus group is strictly confidential and I will not share this information outside of the focus group. *This question is required.
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