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Questions marked with a * are required Exit Survey
 
 
Name
   
 
 
 
* Email Address
   
 
 
 
* Best Phone Number(s)
   
 
 
 
* Gender
 
Male
 
Female
 
 
 
* Age
   
 
 
 
What is the highest level of education you have achieved?
 
Some high school or less
 
High school graduate
 
Some college
 
Currently enrolled in college
 
Business, technical or nursing school
 
College graduate
 
Post Graduate
 
 
 
* What best describes your ethnic background?
 
White, or Caucasian
 
African-American
 
Asian or Pacific Islander
 
Native American
 
Hispanic
 
Hispanic mix (African American/Hispanic)
 
Other
 
 
 
Which of the following technology platforms do you personally have and use daily?
(SELECT ALL THAT APPLY)
 
Android Smartphone
 
iPhone 1, 2, 3 or 4
 
iPhone 5 or 6
 
Other Smartphone
 
iPad
 
Android Tablet
 
Desktop or Laptop Computer

 
 
 
Have you ever successfully downloaded an app onto your current smartphone?
 
Yes
 
No
 
 
 
Can you record a video and take a photo on your smartphone?
 
Yes
 
No
 
 
 
Which of the following beverages would you say you drink on a regular basis?
 
Bottled water
 
Coffee
 
Liquor
 
Wine
 
Beer
 
 
 
How often would you say that you drink alcoholic beverages?
 
More often than once a week
 
Once a week
 
About once every 2-3 weeks
 
About once a month
 
About once every 2-3 months
 
Less often than once every 2-3 months
 
 
Which of the following types of alcoholic beveraes, if any, have you consumed in the past month?
And where did you consume each?
Consumed at Home in Past Month Consumed Out of Home in Past Month
Beer
Vodka
Rum
Whiskey
Single Malt
Cognac
Any Brandy other than Cognac
Tequila
Gin
Wine