Your Full Name
*
Mobile Phone
*
Email
*
What gender do you identify with?
Select Your Gender
Male
Female
Other
No elements found. Consider changing the search query.
List is empty.
What race group do you fall into?
Your Race
Black
White
Coloured
Indian
Other
No elements found. Consider changing the search query.
List is empty.
Province
Select Your Province
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
No elements found. Consider changing the search query.
List is empty.
In which town or city do you live in?
Which one of these best fits with your current life stage?
*
Select your status
I am in high school
I am a student
I am working
No elements found. Consider changing the search query.
List is empty.
What grade are you in?
*
Grade 10
Grade 11
Grade 12
No elements found. Consider changing the search query.
List is empty.
What school are you in?
*
What year of study are you in?
*
1st Year
2nd Year
3rd Year
4th Year
Post-graduate
No elements found. Consider changing the search query.
List is empty.
Are you studying Full-time/ Part-time?
*
Full-time
Part-time
No elements found. Consider changing the search query.
List is empty.
What institution are you studying at?
*
What course are you studying?
*
Which of the below best describes your current work situation?
*
Working part-time
Working full-time
Own my own business
No elements found. Consider changing the search query.
List is empty.
How long have you been working?
*
Been working for 1 to 4 years
Been working for 5 to 10 years
Been working over 10 years
No elements found. Consider changing the search query.
List is empty.
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.
*
Less than R3 499
R3 900 – R5 000
R5 000 – R7 000
R7 000 – R11 000
R11 000 – R16 000
R16 000 – R25 000
R25 000 – R40 000
R40 000 or more
Not Sure
I am not working at the moment
No elements found. Consider changing the search query.
List is empty.
Referred by
Date Of Birth
How old are you?
*
Under 18
19-25 years old
26-34 years old
No elements found. Consider changing the search query.
List is empty.
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?
*
Email
SMS
WhatsApp
All of the above
No elements found. Consider changing the search query.
List is empty.
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.