1. Surveys
  2. 2015
  3. May
  4. C
  5. Critical Insights Database

Critical Insights Database

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Earn cash, gift cards and prizes for sharing your opinion! 

Thank you for your interest in market research focus groups, interviews and online surveys. Please fill out the following information to be added to our database. 
 
 
 
What is your gender?
 
Male
 
Female
 
 
 
What is your age?
 
18-24
 
25-34
 
35-44
 
45-54
 
55-64
 
65+
 
 
 
Are you registered to vote in Maine?
 
Yes
 
No
 
 
 
What is your political affiliation?
 
Republican
 
Democrat
 
Independent/Unenrolled
 
Some other party
 
 
 
Which ONE best describes your current employment status:
 
Employed Full Time
 
Employed Part Time
 
Self Employed
 
Student
 
Retired
 
Homemaker
 
Disabled
 
 
What is your occupation?
   
 
 
What is your job title?
   
 
 
 
Which category best describes your total annual household income?
 
Under $25,000
 
$25,000-$49,999
 
$50,000-$74,999
 
$75,000-$99,999
 
$100,000+
 
 
 
Which ONE best describes your ethnic background?
 
African American
 
White/Caucasian
 
Hispanic/Latino
 
Asian/Pacific Islander
 
Other
 
 
 
 
What is your current marital status?
 
Married
 
Widowed
 
Single/Never Married
 
Living w/Partner
 
Separated/Divorced
 
 
 
What is the highest level of education you have completed?
 
Less than High School
 
High School Graduate
 
2 year/Assoc degree/Tech
 
College Graduate
 
Post Graduate
 
Other
 
 
 
 
First Name : 
Last Name : 
Address 1 : 
Address 2 : 
City : 
State : 
Zip : 
Phone : 
* Email Address : 
 
Critical Insights, Inc.
172 Commercial Street, 2nd Floor
Portland, ME 04101
207-772-4011
[email protected]