Please complete the following survey to provide us with information so that we can better serve you. Your information will be kept private and will not be shared with any other organization.
First Name: *Last Name:
Password:
Do you currently have access to the Internet from home? Yes No
Who currently uses the Internet in your home! (Please check all that apply)
Adult--Male Adult--Female Child--Male Child--Female
Please select the type of Internet access you use from home: Dial-up Cable Modem LAN No access
Briefly explain how you use the Internet in your home:
*Required