1. Do you have Internet access at home? 4. Have you yourself ever used a computer at 6c. When you use the Internet, what kind of □ Yes home, at work, or at school? activities do you do online? (Business □ No (skip to question 3) □ Yes Information further down) □ No □ ... Email friends / family 2. What kind of Internet connection do you □ ... Make purchases online (books, music, have at home? (Check all that apply) 5. Do you have any type of personal electronics, travel, etc.) □ Dial-up telephone line computer, including laptops, in your home? □…Read the news □ DSL enabled phone line □ Yes (skip to question 6) □ ... Read blogs □ Cable TV modem □ No □ ... Play games □ Wireless Connection (land-based or □ ... Pay bills satellite) 5a. What is the main reason you don’t have a □ ... Call long distance or international □ Fiber optic (for example, FiOS or U-Verse) computer at home? □ ... Gather financial information □ T-1 □ Cost/Too Expensive □ ... Gather health information □ Don’t know □ Sufficient access elsewhere □ ... Search for work / employment □ Other (please □ Concern about children’s access □ ... Watch videos/Listen to music specify)___________________________ □ Do not know how to use it □ ... Social networking □ Other(please □ ... Meet new people online (skip to question 6a) specify)_____________________________ 7. What is your age? 3. What is the main reason you do not have 5b. Do you plan to buy a computer to access □ 18 to 24 Internet access? the Internet this year? □ 25 to 34 □ Don’t know how to use it □ Yes □ 35 to 44 □ Use it at school or work □ No □ 45 to 54 □ Don’t need it □ 55 to 64 □ Don’t want it 6. Do you ever go online to access the □ 65 or older □ Not Available Internet or worldwide web or send or receive □ Not a computer person email? 8. How many persons live in your home? □ Don’t really know about computers □ Yes □ 1 □ Don’t want the children to use it □ No (skip to question 7) □ 2 □ Cost/Too Expensive □ 3 □ Other (please 6a. Do you access the Internet using a laptop □ 4 specify)______________________ through a wireless connection? □ 5 □ Yes □ 6 3a. Do you plan to subscribe to an Internet □ No □ More than 6 service this year? □ Yes 6b. Do you access the Internet using a cell 9. Do you speak a language other than □ No phone or handheld device such as an iPhone, English at home? Blackberry or Treo? □ Yes (If yes, what is this language? □ Yes ___________________________) □ No □ No 10. How well do you speak English? 11d. What are the most common barriers 12. Are you a parent, stepparent, or legal □ Very well you experience accessing content online? guardian of any children 18 or under? □ Well □ Color contrast is too low □ Yes □ Not well □ Text size is too small □ No (skip to question 14) □ Not at all □ Non-text objects (images, sound, video) are included with no text alternative 12a. Are any of your children in elementary 11. Does any disability, handicap, or chronic □ Videos are included with no captions school? disease keep you from participating fully in □ Websites are not keyboard accessible □ Yes work, school, housework, or other activities? □ Not enough time is provided to use and □ No □ Yes read content before content changes □ No (skip to question 12) □ Forms are difficult to fill out or form errors 12b. Do you ever visit the website of the are difficult to correct child’s elementary school? 11a. Does your disability or illness make it □ Writing is too difficult to understand □ Yes difficult to use the Internet? □ Websites do not function with my assistive □ No □ Yes technology □ No (skip to question 11e) □ Websites have confusing layouts (please 12c. Are any of your children in middle describe school? 11b. Do you or someone in your house use □ Other (please specify) □ Yes assistive technology to access computers __________________) □ No and/or the Internet? □ Yes 11e. Please select all categories that your 12d. Do you ever visit the website of the □ No (skip to question 11d) disability (ies) would fall under: child’s middle school? □ Learning Disability □ Yes 11c. What type of assistive technology is □ Cognitive/Developmental Disability □ No used? □ Wheelchair user □ Screen reader □ Difficulty walking 12e. Are any of your children in high school? □ Voice Input □ Difficulty with dexterity/hand use □ Yes □ Adapted keyboard □ Totally blind □ No □ Mouth stick □ Partially Sighted/Low vision □ Switch □ Deaf/non ASL user 12f. Do you ever visit the website of the □ Head mouse/pointing device □ Deaf/ASL User child’s high school? □ On–screen keyboard □ Hard of hearing □ Yes □ Screen enlarger/magnification software □ Communication – uses SGD device □ No □ Other(please □ Communication – does not use SGD device specify)___________________________) □ Difficulty speaking 12g. How often does your child use the □ Chronic pain Internet for classroom activities? □ Chronic disease/illness □ 1 to 2 times per week □ Mental/emotional disability □ 3 to 4 times per week □ Other(please specify__________________) □ Everyday □ Never □ Don’t Know 12h. How often is your child asked to use the 13. Where would you prefer to receive □ Government Internet to complete a homework trainings on how to help your children with □ Healthcare assignment? school work? □ Retail Trade □ 1 to 2 times per week □ Local adult school or community college □ Wholesale Trade □ 3 to 4 times per week □ At my child’s school □ Non-classified _________________ □ Everyday □ Local church □ Never □ Community-based organization/non-profit 18. What is this location’s annual □ Don’t Know □ Not interested revenue/sales? □ Other(please specify)__________________ □ Less than $50k 12i. Do your children have access to the □ $50k - $500k Internet after-school outside of the home? 14. Do you own a business? □ $501k+ - $1 million □ Yes □ Yes □ Over $1 million □ No □ No (skip to question 38) □ Don’t Know 19. How many computers at this location 15. Please provide your business’ street have Internet access? 12j. Do you feel comfortable using the address for geographical planning purposes □ None computer to help your child with school only: □ 1 – 5 work? Street Address □ 6 – 10 □ Yes __________________________________ □ 11 – 19 □ No Zip Code □ 20 – 50 __________________________________ □ 51 – 100 12k. Where do your children access the □ Over 100 Internet after-school? 16. How many employees work at this □ After-school program at their school location? 20. Are you using the Internet to support □ Public library □ None your business? □ Community based organization/non-profit □ 1-4 □ yes □ A relative, friend or neighbor’s house □ 5-9 □ No (skip to question 32) □ Home □ 10-19 □ Other (please □ 20-49 specify)_____________________________ □ 50-99 □ 100-249 21. How does this location connect to the 12l. What would help you learn how to use □ 250 or more Internet? the Internet to help your children with school □ Dial-up work? 17. Which of the following best describes the □ DSL □ Trainings at my child’s school type of business conducted at this location? □ Cabell modem □ Videos Check one. □ ISDN line □ Weekend trainings □ Accounting/Architectural/Engineering □ Satellite or microwave □ Evening trainings □ Agricultural/Forestry/Mining □ T1 line □ Online training from home □ Business and Personal Services □ T3/DS3 line □ Other (please specify)_________________ □ Communication/Technology □ Broadband over Powerline □ Contractor or Construction □ Wireless (from service provider) □ Education □ Finance/Insurance/Real Estate 22. What is the name of the company that b) Service and support? □ Distance Learning provides your business’ Internet/bandwidth □ Adequate – meets our needs □ Telemedicine connection? □ Inadequate – does not meet our needs □ Training _____________________________________ □ Transferring data files □ Not Sure 27. How would you describe your overall □ Accounting/Banking satisfaction with you current Internet □ Video-conferencing 23. To the best of your knowledge, how service? □ VPN connections much are you currently paying per month for □ Very satisfied Internet access? □ Somewhat Satisfied 31. If you sell services / products online, □ Under $30 □ Somewhat dissatisfied what percentage of your total sales are □ $30 - $50 □ Very Dissatisfied online sales? □ $50 - $100 a. _____ □ $101 - $300 28. What are your reasons for any □ $301 - $500 dissatisfaction with your current Internet 32. If your business does not subscribe to an □ $501 - $1000 service? Internet service or a higher speed Internet □ $1000 - $1500 □ Price too high service, why not? □ Over $1500 □ Service is unreliable □ Not available □ Don’t know □ Lack of technical support □ Not reliable or secure □ Connection too slow/not enough bandwidth □ Too expensive 24. What is your current Internet bandwidth □ Problems with Email □ Not interested or connection speed? □ Poor customer service □ Less than 200K bps □ 200K bps to 512K bps 29. If an affordable wireless high-speed □ 512+K bps to 1.5M bps Internet service were available to you, how 33. Please indicate the phone service(s) used □ 1.5M bsp to 3M bps likely would you be to utilize this access at this location and your total monthly □ 3+M bps to 5M bps method for your business needs? expenses for each: □ 5+M bps to 10M bps □ Very likely □ Greater than 10M bps □ Somewhat likely a) Regular telephone service (wired): □ Not sure □ Not likely □ Yes □ No 25. How important is Internet/bandwidth □ Under $100 access to your business? 30. For what purpose(s) does this business □ $100- $300 □ Very Important or Critical currently utilize an Internet connection? □ More than $300 □