Digital Equity Questionnaire Question Title * 1. Full Name Question Title * 2. Age Question Title * 3. Address Address 1 Address 2 Question Title * 4. Phone Number Question Title * 5. Do you receive any of the following? Please check all that apply. SNAP MassHealth Public Housing Disability Benefits Section 8 Housing Question Title * 6. Do you have internet access at home? Yes No Question Title * 7. What devices do you own? Check all that apply. Tablet (iPad) Laptop Computer Smart Phone Question Title * 8. Is internet access a financial burden for you? Yes, always Sometimes Rarely No, never Question Title * 9. Please tell us your concerns about internet. Submit
