PERCEPTIVE PROJECT COST ESTIMATE REQUEST

TYPE OF RESEARCH DESIRED: TYPE OF DATA COLLECTION DESIRED:
General/Targeted Population Research
Consumer Research
Business Research
Employee/Membership Research
Developmental Research (Product/ Service/
        Concept/ Campaign/ Program)
Evaluation/Measurement/Assessment
Social/Behavioral/Health/Education/Policy Research
Other types of research: 		CATI Telephone Interviewing
Focus Groups (number of groups):
Field Interviewing
In-depth interviews
Mail Survey
On-line Survey
Mystery Shop Program
Other Type of Data Collection:
PROJECT SPECS:
Start/End date:
Subject:
Geographic coverage:
Sample size (completed interviews desired):
Length of questionnaire:
Number of open-ended questions:
Budget (not required for an estimate):
RESEARCH RESPONDENTS:
General U.S. population
Caucasian
African-American
Hispanic
Other targeted U.S. (Haitian, Asian,
Native American, etc.) 
Other countries: 		Type in specific age range numbers:
   
Additional respondent criteria:
   
Incidence, if known:
   
FOCUS GROUP MODERATOR(S): RESEARCH DELIVERABLES: TRANSLATE:
Female
Male
African-American
Hispanic
Caucasian
Asian
Haitian
Other: 
A. Survey Questionnaire
B. Focus Group Screener
C. Focus Group Discussion Guide
D. Interview/Focus group transcript
E. Other:

From English to:
Spanish
Other language (specify):
Data on disc
Top-Line Report/Frequencies
Banners/Cross-tabulation
Full Quantitative or Qualitative Report with
        executive summary, key findings, conclusions
        and recommendations
Additional Advanced Statistical Analyses
   
YOUR CONTACT INFORMATION:
* Name: * Phone:
Title: Fax:
Company, Organization
or Agency:		 * Email:
Address: Web Site:
City:  How would you like us to reply? Phone
Fax
Email
US Mail
State:
Zip:  
ADDITIONAL PROJECT INFORMATION: