DIRECT COMMUNITY AUDIT FORM: Faculty

1. Public Media Corps Community Survey (Schools)

Thank you for taking the time to participate in this brief Public Media Corps survey. Public Media Corps fellows are community media helpers who work in schools and community anchor organizations to give teachers, parents, and students improved access to a changing world of broadband connectivity and online communication.

Your information will help these fellows design media teaching aides, school events, student, and community activities/training designed to provide basic, and advanced information on connecting to a networked world for relevant and life-improving information.

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* 1. What is your email address?

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* 2. What is your residential zip code?

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* 3. Who is your mobile phone provider/carrier?

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* 4. Who is your local Internet access provider?

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* 5. What is your role at this school? If “teacher” please list subject(s) you teach.

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* 6. What is home address? (optional)

Address:

Address 2:

City/Town:

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* 7. What is your race?

Asian Indian

American Indian or Alaska Native (Print name of enrolled or principal tribe in comments box)

Black or African American

Chinese

Filipino

Guamanian or Chamorro

Japanese

Korean

Native Hawaiian

Other Asian (Please print race, for example, Hmong, Laotian, Thai, Pakistani, Cambodian, and so on in comments field below)

Other Pacific Islander (Please print race, for example, Fijian, Tongan, and so on in the comments field below)

Samoan

Vietnamese

Some other race (Please print race in comments field below)

Comments:

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* 8. How do you usually access the Internet at home?

I do not have Internet access at home

Mobile smart phone

Desktop computer

Laptop or netbook

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* 9. If you have Internet access at home, how fast is your connection?

I can download full length movies online, stream long video clips, and browse the web instantly

It takes too long to stream video but I can check email and browse large images, and text-based web pages within seconds

I can really only browse text-based web pages quickly; images, video, and other media always take too long to load/download.

DIRECT COMMUNITY AUDIT FORM: Faculty

1. Public Media Corps Community Survey (Schools)

Question Title

* 1. What is your email address?

Question Title

* 2. What is your residential zip code?

Question Title

* 3. Who is your mobile phone provider/carrier?

Question Title

* 4. Who is your local Internet access provider?

Question Title

* 5. What is your role at this school? If “teacher” please list subject(s) you teach.

Question Title

* 6. What is home address? (optional)

Question Title

* 7. What is your race?

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* 8. How do you usually access the Internet at home?

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* 9. If you have Internet access at home, how fast is your connection?

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* 10. How many devices in your home access the Internet?

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* 11. How many people in your home access the Internet?