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Welcome! Here’s the next step in continuing your application to join Digital Reflection Panel.
Please fill out the following questions completely and accurately. Do not click your browser's back button as you may lose information that you've entered. |
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* Is there a wireless network router (WiFi) for connecting to the internet in your home with at least one open port? |
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* Are you the responsible party for the wireless network router? |
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Do you have an agreement with any of your neighbors to regularly share access to your Internet account/WiFi network (without regard to how or if you split the costs)? |
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* Are there children in the household? |
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* Are you the parent or guardian of all children in the household? |
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* Do you or any members of your household work for or participate in a market research company? |
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| You said yes to the previous question, name the Market Research company: | | |
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How many of the following devices that can connect to the internet are there in your home? Please include only devices that are currently in use.
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* How many televisions do you have in your household? |
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* What type of TV service does your household use? Select all that apply. |
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* Who is your household's current cable TV service provider? |
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* Who is your household's current satellite TV service provider? |
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* Who is your current home Internet Service Provider (ISP)? |
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If you become a panel member, we may need to contact you for periodic updates. A contact number is very important. This number will not be used for any other purposes other than by Digital Reflection Panel to contact you regarding membership.
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Do you agree to allow Digital Reflection to call you for membership related questions? |
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* How many people, including yourself and any children, regularly live in your household? Please EXCLUDE any family members living away at school during the school year. |
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* For classification purposes only, what is your household’s annual income before taxes? |
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Please complete the following information about each member within your household, which includes yourself. |
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| * Household member first name? | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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| Household member first name? | | |
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* What is this person’s birthdate? |
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Month | Day | Year | | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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| * Household member first name? | | |
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* What is this person’s birthdate? |
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Month | Day | Year | | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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| * Household member first name? | | |
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* What is this person’s birthdate? |
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Month | Day | Year | | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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| * Household member first name? | | |
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* What is this person’s birthdate? |
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Month | Day | Year | | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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| * Household member first name? | | |
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* What is this person’s birthdate? |
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Month | Day | Year | | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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| * Household member first name? | | |
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* What is this person’s birthdate? |
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Month | Day | Year | | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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| * Household member first name? | | |
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* What is this person’s birthdate? |
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Month | Day | Year | | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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| * Household member first name? | | |
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* What is this person’s birthdate? |
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Month | Day | Year | | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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| * Household member first name? | | |
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* What is this person’s birthdate? |
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Month | Day | Year | | | |
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* What is this person’s gender? |
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* Is this person the head of the household? |
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* Does this person routinely use an internet connected device at home? |
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* What is the last grade of school this person completed? |
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* What is this person’s current employment status? |
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* What is this person’s race? (Select all that apply) |
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* Is this person of Spanish, Hispanic, or Latino origin? |
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* Which language does this person prefer to speak most often? |
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* What language does this person use most frequently when reading news, watching videos, or keeping up with friends? |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Previously, you told us there are mobile phone(s) in your household. Please tell us what type each one is.
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Who is the primary user of each phone?
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Previously, you told us there are tablet(s) in your household. Please tell us what type each one is.
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Who are the household member(s) that use the tablet(s)?
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script |
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You're almost done! Click continue to review our privacy policy and agree to the terms in order to complete your panelist application.
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