DIRECT COMMUNITY AUDIT FORM: Community Survey

THANK YOU FOR COMPLETING THE SHORT SURVEY!

Please continue with our additional questions below, only if you are interested in entering our drawing for local prizes. Consult with a PMC Fellow for further details on the great prizes available in your area! Thank you very much for your time, and focus.

***PLEASE NOTE THAT YOUR UNIQUE ID INFORMATION IS REQUIRED TO COMPLETE THIS PAGE OF THE SURVEY.

*
1. In order to track your entry in our contest, please create a unique ID using your initials and the last-four (4) digits of your phone number. (For example Anita Johnson's number could be "AJ2334," because her mobile phone number ends in "2334")

In order to track your entry in our contest, please create a unique ID using your initials and the last-four (4) digits of your phone number. (For example Anita Johnson's number could be "AJ2334," because her mobile phone number ends in "2334")

2. Who is your mobile phone provider/carrier?

Who is your mobile phone provider/carrier?

3. What is your annual household income?

What is your annual household income? Less than $25,000

$25,000 - $35,000

$35,000 - $45,000

$45,000 - $55,000

$55,000 - $65,000

Over $65,000

4. If you have the Internet at home, how many people in your home access the Internet through each of the following sources?

If you have the Internet at home, how many people in your home access the Internet through each of the following sources? Mobile smart phone
Desktop computer
Laptop or netbook
iPod or iPad

5. How frequently do you use the Internet?

How frequently do you use the Internet? Very frequently (several times a day)

Somewhat frequently (every day)

Frequently (every week)

Rarely

Never

6. How familiar are you with the following digital and social media web tools?

	Very familiar (I use this often)	Somewhat familiar (I've seen it used, or I've used it once)	Not familiar (I am not sure what this is)
Facebook, MySpace or other social network	*How familiar are you with the following digital and social media web tools? Facebook, MySpace or other social network Very familiar (I use this often)	Facebook, MySpace or other social network Somewhat familiar (I've seen it used, or I've used it once)	Facebook, MySpace or other social network Not familiar (I am not sure what this is)
Twitter	Twitter Very familiar (I use this often)	Twitter Somewhat familiar (I've seen it used, or I've used it once)	Twitter Not familiar (I am not sure what this is)
Google, Yahoo!, or other search engine	Google, Yahoo!, or other search engine Very familiar (I use this often)	Google, Yahoo!, or other search engine Somewhat familiar (I've seen it used, or I've used it once)	Google, Yahoo!, or other search engine Not familiar (I am not sure what this is)
PayPal, Amazon.com or other buying tools/sites	PayPal, Amazon.com or other buying tools/sites Very familiar (I use this often)	PayPal, Amazon.com or other buying tools/sites Somewhat familiar (I've seen it used, or I've used it once)	PayPal, Amazon.com or other buying tools/sites Not familiar (I am not sure what this is)
Wikipedia	Wikipedia Very familiar (I use this often)	Wikipedia Somewhat familiar (I've seen it used, or I've used it once)	Wikipedia Not familiar (I am not sure what this is)
Digg, or other web bookmarking site	Digg, or other web bookmarking site Very familiar (I use this often)	Digg, or other web bookmarking site Somewhat familiar (I've seen it used, or I've used it once)	Digg, or other web bookmarking site Not familiar (I am not sure what this is)

DIRECT COMMUNITY AUDIT FORM: Community