User Survey (via Mowser)

Survey Security

*Password:

Personal Information

*How did you here about us?

Television
Radio
Newspaper
Friend
Search Engine
User Group
Direct Mail
Telemarketing
Other

*What is your gender?

Male
Female

*How would you classify yourself?

Rather not say
Caucasian/White
African American
Indigenous or Aboriginal
Asian/Pacific Islander
Hispanic
Latino
Multiracial
Other

*What is your marital status?

Rather not say
Single
Married
Divorced
Widowed

*What is your age?

Rather not say
Under 13
13 - 15
16 - 20
21 - 25
26 - 29
30 - 39
40 - 49
50 - 59
60 - 69
70 or above

*What is your annual household income?

Rather not say
Under $10,000
$10,000 - $19,999
$20,000 - $29,999
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 _ $69,999
$70,000 - $79,999
$80,000 - $89,999
$90,000 - $99,999
$100,000 or above

*Where are you located?

U.S. North East
U.S. South East
U.S. Mid West
U.S. Great Plains
U.S. North West
U.S. South East
Canada

*Describe the area you live in.

Urban
Suburban
Rural

*What is highest level of education completed?

Grammar School
High School or equivalent
Vocational/Technical School
Some College
Associates Degree (2 year)
College Graduate (4 year)
Master`s Degree (MS)
Doctoral Degree (PhD)
Professional Degree (MD etc.)
Other

*Are you currently registered to vote?

Yes
No

*How many children live in your household?

None
1
2
3
4 or more

Employment or Business Information

*What type of industry do you work in?

*What type of role do you perform?

Upper Management
Middle Management
Junior Management
Administrative Staff
Support Staff
Student
Trained Professional
Skilled Laborer
Consultant
Temporary Employee
Researcher
Self-employed/Partner
Other

*The organization you work for is in which of the following:

Public sector (government)
Private sector (businesses)
Not-for-profit sector
Don`t know
Other

*The main source of revenue for your organization is:

Sales to individuals
Sales to private businesses
Sales to government
Contracts to individuals
Private business contracts
Government contracts
Other organization contracts
Government appropriations
User charges and fees
Donations
Other
Don`t know

Internet Usage Information

*Which of these groups have you become more connected to through the Internet?

None
Common political groups
Common hobbies/recreational
People who share my religion
People in my profession
People in my family
Common life situations
Other groups

*How often do you give false information on the internet?

Never falsified information
Under 25% of the time
26 - 50% of the time
51 - 75% of the time
Over 75% of the time
Never registered with a site

*How long have you been using the Internet?

Less than 6 months
6 to 12 months
1 to 3 years
4 to 6 years
7 years or more

*Home web access: How often?