Sign up to become a consumer panelist


 
       NOTE: In order to help us properly fit you into the appropriate tests, please answer the following questions truthfully.       
 


     Your Personal Data 

  1. Name and contact information:
    2. First Name:  
    Last Name:  
    Email Address:  
    Phone Number:  
    Address data is optional
    Mailing Address Line 1:  
    Mailing Address Line 2:  
    City:  
    State:  
    Zip:  
  2. Your gender is:
    3.  Male
     Female
  3. To which of the following age categories do you belong?
    4.  Under 18
     18-25
     26-35
     36-45
     46-55
     56-65
     Over 65
  4. Which category best represents your annual household income (in U.S. dollars)?
    5.  Less than 10,000 per year
     10,000-20,000 per year
     20,001-35,000 per year
     35,001-45,000 per year
     45,001-55,000 per year
     55,001-75,000 per year
     75,001-100,000 per year
     Over 100,001 per year
  5. Do any of these medical conditions apply to you (check all that apply)?
    6.  Severe Asthma/Allergies
     High Blood Pressure
     Hypoglycemia
     Lactose Intolerance
     Diabetes
     Food Allergies
     Other
     None
  6. If you indicated that you have food allergies above, please list the foods to which you are allergic:
  7. If you indicated that you have other medical conditions above, please list these conditions:
  8. You may be asked to taste a wide variety of products including dairy foods, foods which are high in artificial sweeteners, sugar, fat, cholesterol, and carbohydrates. Does this present any problems?
    9.  No
     Yes
  9. If you indicated that you would have problems with tasting foods in the question above, please clarify:
  10. All tasting is on a part time only basis. However, we have a few opportunities for regular employment (6-9 hours per week). Please indicate how available you are for tasting as a part-time activity:
    11.  Weekly (6-9 hours per week)
     1-2 times per month
     Once every 2-3 months
     Once every 4-6 months
     1-2 times per year
     Less than 1 time per year
     Your Consumption Habits 

  11. Are you a vegetarian?
    12.  No
     Yes  If yes, please skip next question regarding meat consumption habits.

    Meats

  12. Please indicate the types of meat you consume (check all that apply):
    13.  Beef
     Chicken
     Fish
     Lamb/Mutton
     Pork
     Game/Wild Meat (e.g. deer, duck, etc.)
     Turkey

    Snack Foods

  13. Please indicate the types of snack foods you consume (check all that apply):
    14. Salty Snacks               Sweet Snacks
     Chips
     Crackers
     Pretzels
     Nuts
     Popcorn
    		                Cakes
     Brownies
     Cookies
     Pies/Cobblers
     Doughnuts/Pastries
     Candies/Confections

    Dairy Foods

  14. Please indicate the types of dairy foods you consume (check all that apply):
    15.  Ice Cream
     Yogurt
     Cheese
     Milk
     Butter
     Margarine

    Canned Vegetables

  15. Please indicate the types of canned vegetables you consume (check all that apply):
    16.  Corn
     Hominy
     Green Beans
     Sweet Potatoes
     Spinach
     Baked Beans
     Carrots
     Peas
     Asparagus
     Pork -n- Beans

    Nutrition Supplements/Weight Management Products

  16. Please indicate the types of nutrition supplements or weight management products you consume (check all that apply):
    17.  Meal Replacement Bars
     Protein Energy Bars
     Weight Management Snacks
     Fortified Soups/Pastas
     Meal Replacement Drinks/Shakes
     Protein/Energy Drinks/Shakes
     Fortified Supplemental Drinks/Shakes
     Low Carb Bars/Shakes
     Never used these types of products

    Flavors, Spices, and Seasonings

  17. Please select the option below that best describes your opinion of the following flavors, spices, and seasonings:
    18.   Like Indifferent Dislike
    Vanilla
    Peach
    Strawberry
    Grape
    Raspberry
    Orange
    Pineapple
    Lemon/Lime
    Cherry
    Banana
    Apple
    Cranberry
    Chocolate
    Caramel
    Coffee
    Onions
    Garlic
    Sage
    Black Pepper
    White Pepper
    Green Herbs
  18. Are there any foods you do not like to eat:
    19. No
    Yes
  19. If you indicated that there are foods you do not like to eat above, please list these foods:
  20. Are there any foods you cannot or will not eat for any reason?:
    21. No
    Yes
  21. If you indicated that there are foods you cannot or will not eat above, please list these foods:


    		22.
     Taste Test Proceeds 

  22. What would you like to do with the proceeds of a test if you are selected to participate:
    23. I would like to personally receive the proceeds from my taste sessions.
    I would like to donate the proceeds of my taste sessions to the charity of my choice.
  23. If you indicated above that you would like the proceeds of your taste tests to go to a charity, please indicate the charity:
    24. Select a charity from the list, or choose 'Other' if the desired one is not listed:
    NOTE: The pre-listed charities are ones which have been requested by previous consumers and do not indicate any bias or preference of the UA Food Science Department.

    If you chose 'Other' in the drop-down menu, please fill in the details for your charity:
    Charity Name:  
    Phone Number:  
    Mailing Address Line 1:  
    Mailing Address Line 2:  
    City:  
    State:  
    Zip: