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Hello:

You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.


Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.


Your survey responses will be stricly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.


Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.


 
 
 
Is surfing the internet safe?
 
Yes all the time
 
Yes sometimes
 
Never
 
Don't know
 
A&W Root Beer
 
Other Comments :
 
 
 
Additional Comments/Suggestions for improvement
   
 
 
 
How did you find about this site? (Please check all that apply.)
 
Followed a text link from another Web page
 
Followed a graphical banner/icon from another Web page
 
Found using a search engine
 
Saw postings to WWW related newsgroups
 
Received e-mail from www-surveying mailing list
 
From a friend
 
Read about it in a newspaper/magazine
 
Remembered to participate from last survey
 
Other
 
 
 
 
What is your primary language (i.e., the one you speak most of the time)?

 
English
 
Spanish
 
French
 
German
 
Dutch
 
Japanese
 
Chinese
 
Hebrew
 
Swedish
 
Other
 
 
 
 
Note: This is a sensitive question that can help Internet developers to understand the needs of current Web users--it is not intended to offend.
Are you disabled or impaired? (Please check all that apply.)

 
Rather not say
 
Vision impaired
 
Hearing impaired
 
Motor impaired
 
Cognitively impaired
 
Other
 

 
 

How frequently do you access the web from the following places?
Daily Weekly Monthly Less than once a month Never
From home (including a home office)
From work
From school
From a public terminal (e.g. library, cybercafe, etc.)
From other places
 
 
 
Who pays for your Internet access? (Please check all that apply.)
 
Self/spouse
 
Parents
 
Work
 
School
 
Other
 
Don't know

 
 
 
Are you currently registered to vote?
 
Rather not say
 
No
 
Yes
 
Not applicable
 
 
 
Which of the following categories best describes the industry you primarily work in (regardless of your actual position)?

Check here if you are
 
Retired or
 
Unemployed
 
Agriculture, Forestry, Fishing and Hunting
 
Utilities
 
Computer and Electronics Manufacturing
 
Wholesale
 
Transportation and Warehousing
 
Software
 
Broadcasting
 
Other Information Industry
 
Real Estate, Rental and Leasing
 
Primary/Secondary (K-12) Education
 
Health Care and Social Assistance
 
Hotel and Food Services
 
Legal Services
 
Homemaker
 
Religious
 
Mining
 
Construction
 
Other Manufacturing
 
Retail
 
Publishing
 
Telecommunications
 
Information Services and Data Processing
 
Finance and Insurance
 
College, University, and Adult Education
 
Other Education Industry
 
Arts, Entertainment, and Recreation
 
Government and Public Administration
 
Scientific or Technical Services
 
Military
 
Other
 
 
 
 
Please indicate the highest level of education completed.
 
Grammar School
 
High School or equivalent
 
Vocational/Technical School (2 year)
 
Some College
 
College Graduate (4 year)
 
Master's Degree (MS)
 
Doctoral Degree (PhD)
 
Professional Degree (MD, JD, etc.)
 
Other
 
 
 
What is your sex?
 
Female
 
Male
 
 
 
Which of the following best describes the area you live in?
 
Urban
 
Suburban
 
Rural
 
 
 
What is your age?
   
 
 
 
How did you find about this site? (Please check all that apply.)
 
Followed a text link from another Web page
 
Followed a graphical banner/icon from another Web page
 
Found using a search engine
 
Saw postings to WWW related newsgroups
 
Received e-mail from www-surveying mailing list
 
From a friend
 
Read about it in a newspaper/magazine
 
Remembered to participate from last survey
 
Other
 
 
 
 
What is your primary language (i.e., the one you speak most of the time)?

 
English
 
Spanish
 
French
 
German
 
Dutch
 
Japanese
 
Chinese
 
Hebrew
 
Swedish
 
Other
 
 
 
 
Note: This is a sensitive question that can help Internet developers to understand the needs of current Web users--it is not intended to offend.
Are you disabled or impaired? (Please check all that apply.)

 
Rather not say
 
Vision impaired
 
Hearing impaired
 
Motor impaired
 
Cognitively impaired
 
Other
 

 
 

How frequently do you access the web from the following places?
Daily Weekly Monthly Less than once a month Never
From home (including a home office)
From work
From school
From a public terminal (e.g. library, cybercafe, etc.)
From other places
 
 
 
Who pays for your Internet access? (Please check all that apply.)
 
Self/spouse
 
Parents
 
Work
 
School
 
Other
 
Don't know

 
 
 
Are you currently registered to vote?
 
Rather not say
 
No
 
Yes
 
Not applicable
 
 
 
Which of the following categories best describes the industry you primarily work in (regardless of your actual position)?

Check here if you are
 
Retired or
 
Unemployed
 
Agriculture, Forestry, Fishing and Hunting
 
Utilities
 
Computer and Electronics Manufacturing
 
Wholesale
 
Transportation and Warehousing
 
Software
 
Broadcasting
 
Other Information Industry
 
Real Estate, Rental and Leasing
 
Primary/Secondary (K-12) Education
 
Health Care and Social Assistance
 
Hotel and Food Services
 
Legal Services
 
Homemaker
 
Religious
 
Mining
 
Construction
 
Other Manufacturing
 
Retail
 
Publishing
 
Telecommunications
 
Information Services and Data Processing
 
Finance and Insurance
 
College, University, and Adult Education
 
Other Education Industry
 
Arts, Entertainment, and Recreation
 
Government and Public Administration
 
Scientific or Technical Services
 
Military
 
Other
 
 
 
 
Please indicate the highest level of education completed.
 
Grammar School
 
High School or equivalent
 
Vocational/Technical School (2 year)
 
Some College
 
College Graduate (4 year)
 
Master's Degree (MS)
 
Doctoral Degree (PhD)
 
Professional Degree (MD, JD, etc.)
 
Other
 
 
 
What is your sex?
 
Female
 
Male
 
 
 
Which of the following best describes the area you live in?
 
Urban
 
Suburban
 
Rural
 
 
 
What is your age?
   
 
Please contact [email protected] if you have any questions regarding this survey.
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