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* 1. Contact Info:

* 2. Gender:

* 3. Date of Birth (Ex. 08/25/1987)

* 4. Industry & Title:

* 5. What best describes your marital status?

* 6. What best describes your annual household income?

* 7. What best describes your ethnicity?

* 8. How many nights in a typical week do you watch at least an hour of television, either live or on DVR or Tivo, that airs between 5pm and 11pm Monday-Friday, not including weekends?

* 9. For each of the following topics, please tell us if you make an effort to follow it very closely, somewhat or not at all.

  Very Closely Somewhat Not at all
Sports
Entertainment
Politics
Current Events
Science
Business
Fashion
Arts
World News
Culture

* 10. In a typical week Monday -Friday, not including weekends, how many hours of TV news programming do you watch? (Write hours and minutes)

* 11. Overall, what is your impression of the following TV Networks? On a scale of 1-10, where 1 means "I really don't like this network" and 10 means "I love this network", how would you rate the following

  1 2 3 4 5 6 7 8 9 10
Bravo
CNN
Discovery Channel
FOX News
MSNBC
Comedy Central

* 12. For each media source please tell us how often you consume media from that source

  Daily Weekly Monthly Seldom Never Not Familiar
HuffingtonPost.com
Slate.com
DailyKOS.com
CommonDreams.org
Politico.com
DemocracyNow.org
CrooksandLiars.com
ThinkProgress.org
TalkingPointsMemo.com
Salon.com
Alternet.org
TheNation.com
Mediamatters.org
RealClearPolitics.com
Trueslant.com
MSNBC.com
NPR.com
NPR
Air America Radio
The Daily Show w/John Stewart
DemocraticTalkRadio.com
Real Time with Bill Maher
FireDogLake.com
DailyBeast.com

* 13. What is the make and model of your current mobile phone?

* 14. Where did you hear about this study?

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