* 1. Today's date

Date / Time
/
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* 2. Student Contact Information

* 3. What is your age?

* 4. Gender (choose one)

* 6. What are your interests?

* 7. Do you own a phone or mobile device (e.g. tablet)?

* 8. What phone do you have ?

* 9. What do you use your laptop, mobile device or phone for and how often (check all that apply)?

  Not at all Once a week On weekends Everyday 5-10 times/week More >10 times/day  N/A
Make or receive phone calls
Send or receive text messages
Send or receive instant messages
Send or receive emails
Use social network: Facebook, Instagram, Snapchat
Browse the Internet (Google)
Play games
Send or receive photos/videos
Take photos
Record videos
Play music
Purchase products

* 10. Who is your phone service provider?

T