Name:

Phone:

Type of Organization:

1. What is the purpose of the research? How will the results be applied?

2. What should the report on the findings contain? (Recommendations, frequencies, percentages...)

3. What kind of data is required? For example:

 Age
 Marital Status
 Union Membership
 Household Income
 Gender

 Other:

4. What kind of data analysis is required? For example, cross-tabulating data shows if opinions on one subject are correlated with attitudes about other issues.

5. What sample size and sample design are required? To ensure even small audiences have a voice, should the poll over-sample any small groups in the target population? For example, quota samples specify a minimum number of interviews in different groups such as 200 men and 200 women, or at least 150 interviews in each region, area and so on.

6. Do any sources exist for the information you want? Are there earlier polls whose questions we should update or track?

7. What method should be used to collect the data?

Please select ... Phone interviews In-person interviews Mail Focus groups Online Web site Not sure

 Other:

8. Who approves the questionnaire?

9. Who receives the final report? (This influences the recommendations.)

10. When do we need the results?

  Other comments or requests:

We will contact you soon to discuss your project.