DIRECT COMMUNITY AUDIT FORM: Parents

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 parents, students, and teachers improved access to a changing world of broadband connectivity and online communication.

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

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* 1. What is your email address? (optional)

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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. What is your home address? (optional)

Address:

Address 2:

City/Town:

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

Mobile smart phone

Desktop computer

Laptop or netbook

I do not have Internet access at home

DIRECT COMMUNITY AUDIT FORM: Parents

1. Public Media Corps Community Survey (Schools)

Question Title

* 1. What is your email address? (optional)

Question Title

* 2. What is your residential zip code?

Question Title

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

Question Title

* 4. What is your home address? (optional)

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* 5. What is your race?

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

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* 7. Who is your local Internet access provider?

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

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