TYPE OF RESEARCH DESIRED: TYPE OF DATA COLLECTION:
General/Targeted Population Research
Consumer Research
Business Research
Employee/Membership Research
Product/ Service/ Concept/ Campaign/ Program/Developmental Research
Evaluation/Measurement/Assessment
Social/Behavioral/Health/
Education/Policy Research
Other types of research: 		CATI Telephone Interviewing
Focus Groups (# of groups)
Field Interviewing
In-depth interviews
Mail Survey
On-line Survey
Mystery Shops
Other Type of Data Collection:
PROJECT SPECS:
Start/End date:
Subject:
Geographic coverage:
Sample size (number of completed interviews):
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 (young children, pre-teens, teens, young adults, middle adults, senior adults, elderly)
   
Additional demographic criteria:
   
Incidence, if known:
   
RESEARCH DELIVERABLES: FOCUS GROUP MODERATOR(S):
Data on disc
Top-Line Report/Frequencies
Banners/Cross tabulation
Full Quantitative or Qualitative Report with executive summary, key findings, conclusions and recommendations
Focus Group/In-depth Interviewing Transcriptions
Other:
Translate from English to
(language)		 Female
Male
African-American
Hispanic
Caucasian
Asian
Haitian
Other: 
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: