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* 1. First Name

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* 2. Last Name

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* 3. Adult's Email address

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* 4. Adult's Gender

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* 5. Adult's Date of Birth (MM/DD/YYYY)

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* 6. With which group do you most identify?
You may select more than one option.

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* 7. What is your age?

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* 8. What is your highest educational level? 

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* 9. What is your employment status?

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* 10. What is your approximate annual household income?

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* 11. How many members are in your household (including yourself)?

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* 12. Have you participated in any Tech Goes Home class before?

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* 13. What is the main reason you decided to participate in Tech Goes Home?

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* 14. Which devices do you use at home?
You may select more than one option.

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* 15. How many internet-capable devices do you have at home?

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* 16. Which best describes your level of computer skills?

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* 17. How do you access the Internet in your home?
You may select more than one option.

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* 18. If you have a home wi-fi router, what service do you use?
Leave this question blank if none.

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* 19. If you have a mobile data plan, which service do you use?
Leave this question blank if none.

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* 20. Have you ever changed or cancelled your Internet subscription (wi-fi or mobile data) because it was too expensive?

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* 21. I hereby give the unqualified right to the Tech Goes Home Tennessee (TGH TN) program to take pictures and/or video of myself. I give permission for these images as well as materials that we have created in the TGH TN program to be used in print and web-based publications. The TGH TN program will put these images to legitimate use without limitation or reservation.

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* 22. Would you be interested in speaking with someone about your experience with this program? This could be on the phone or online and you will receive $50 for your time.

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