Please Complete The Survey Below:

Your Full Name *

Mobile Phone *

Email *

What gender do you identify with?

What race group do you fall into?

Province

In which town or city do you live in?

Which one of these best fits with your current life stage? *

What grade are you in? *

What school are you in? *

What year of study are you in? *

Are you studying Full-time/ Part-time? *

What institution are you studying at? *

What course are you studying? *

Which of the below best describes your current work situation? *

How long have you been working? *

What work do you do? *

What is your GROSS PERSONAL monthly income (before tax and deductions – include all sources of income, i.e. side hustle, salaries, pension, income from investments, etc)? NOTE: None of your personal information is ever shared with anyone else and only used for survey specifications. *

Referred by

Date Of Birth

How old are you? *

Please can you get your parent / guardian to sign that they give you permission to sign up for and take part in the YDx Youth Matters research panel.

Parent Name *

Parent Mobile Phone *

Parental Consent *

As Parent/ Guardian of the respondant, I hereby give them permission to sign up to take part in the YDx Youth Matters market research panel

How would you want to be notified of surveys from us? *

POPI Consent *

I give consent for my personal information to be used in strict compliance with the Protection of Personal Information Act, 4 of 2013 (POPIA). My personal information may not be shared with (or sold to) a 3rd party. I also understand I may opt out from communication at any time.