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Hello:

You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.


Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.


Your survey responses will be stricly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.


Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.


 
 
 
Additional Comments/Suggestions for improvement
   
 
 
 
In an average month, about how much does your total household spend on gasoline?
 
less than $25
 
$25 - $50
 
$50 - $75
 
$75 - $100
 
over $100
 
 
 
Which of the following age groups do you fall into?
 
18-24
 
25-34
 
35-44
 
45-49
 
50-54
 
55-64
 
65 or older
 
 
 
What is your marital status?
 
single
 
married
 
separated
 
divorced
 
widowed
 
 
 
How many of your children do you have living at home?
 
one
 
two
 
three
 
four
 
five
 
six or more
 
 
 
Just approximately, which income category best describes your total annual household income?
 
under $25,000
 
$25,000 - $34,999
 
$35,000 - $49,999
 
$50,000 - $74,999
 
$75,000 - $99,999
 
$100,000 - $119,999
 
over $120,000
 
Please contact [email protected] if you have any questions regarding this survey.
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