Rockbridge Residential Survey

Name: *

Street Address:

City:

State:

Zip:

Phone:

E-mail: *

Number of people in household:

Total Number of Computer Users:

Do you have an Internet Connection:

Yes

No

If yes, what type?:

How much do you pay now for Internet access each month?:

How important is Internet access to you or your household?:

Very Important

Somewhat Important

Not Important

No Opinion

How satisfied are you with your current landline telephone service?:

Not at all Satisfied

Somewhat Satisfied

Satisfied

Very Satisfied

How satisfied are you with TV service (cable or satellite)?:

Not at all Satisfied

Somewhat Satisfied

Satisfied

Very Satisfied

How satisfied are you with the speed of your current Internet service?:

Not at all Satisfied

Somewhat Satisfied

Satisfied

Very Satisfied

If you are still on dial up, (no broadband connection), why are you?:

No broadband options in my area

Too expensive

Not interested

Lack of help/support

Would you be willing to pay more for faster, higher quality Internet access?:

Not at all willing

Somewhat willing

Very willing

Not sure

Check all items you use the Internet for now:

Check all uses you might use in in the future:

Does anyone in your household use the Internet to complete school assignments or job training course work?:

Yes, several times a week

Yes, at least once a week

Yes, at least once a month

No

How difficult is it to find help and training for things you would like to do on the computer or on the Internet?:

Very Difficult

Somewhat Difficult

Not Difficult

If you need better, more affordable, services at your home, please indicate below:

Telephone

Internet/data

TV

For your household, how much do you spend each month for local and long distance telephone, TV, and Internet?
Do NOT include cellphones.:

Who is your Internet Service provider?:

Who is your cable/satellite TV provider?:

Who is your local dial-tone telephone service provider?:

Who is your long-distance telephone service provider?:

What other telecommunication needs do you have that were not covered in this survey?:

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