Demographic Information Questionnaire

(Please note, your information will not be sold or given to outside entities. It is for internal use only.)

1. Name: ___________________________________________
2. Type:

Teacher

3. Grade Level:

Student

General Public

Elementary

Middle School

High School

College

4. Years Using the Web: _______________

5. Age Group:
6. Gender:

5-10

Female

11-13

14-17

18-24

25-34

35-44

45-55

over 55

Male

7. How often do you use the internet?

Daily

Weekly

Monthly Occasionally

Never

8. What do you usually do on the internet? (e.g., email, use reference materials such as
encyclopedias and dictionaries, read news, curriculum activities, games, entertainment
etc.)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
9. May we contact you about your input at a later date?
If so, please provide your e-mail address. _______________________________