Broadband Survey

NOTE: Only one survey per household. "Required" means we need the answer to this particular question.

What is the county or city in which your residence is located? *

Please provide your full home address. (Follow the examples exactly. No PO Box numbers. This is only used to identify demand for broadband services.)

Street address (example: 555 Main St.) *

City (example: Springfield) *

Zip Code (5 digits only, example: 23456) *

Neighborhood name (if applicable)

Neighborhood name (if applicable):

Do you subscribe to the Internet at home? *

Yes

No

What do you use your home Internet for? (Check all that apply. Business information further down.)

Describe "other" below:

What would you like to be able to do online that you can't with your current home connection (or lack thereof)? (Check all that apply)

Describe "other" below:

Select an option that best describes both your household size (including yourself) and household income*. *

*TOTAL HOUSEHOLD INCOME IS DEFINED AS INCOME ALL HOUSEHOLD MEMBERS OVER THE AGE OF 17 RECEIVE FROM ALL SOURCES, SUCH AS WAGES, SALARIES, INTEREST INCOME, INVESTMENT INCOME, SOCIAL SECURITY, PUBLIC ASSISTANCE, OR OTHER SOURCES.

If an affordable, faster Internet option were offered to your household, would you be willing to commit to a year-long contract to take that service?

Yes

No

How much would you be willing to spend for faster Internet service?

under $50/month

$50 - $100/month

$100 - $150/month

over $150/month

What kind of phone service do you rely on most at home?

Landline

Cellular

Voice Over Internet Protocol (VOIP)

Other

Describe "other" below:

Is your home phone service consistently reliable?

Yes

No

Are there any children in K-12 living at this home address, including home schooled?

Yes

No

Describe "other" below:

Do you own a business within the same county or city as your home address?

Yes, I own a traditional storefront business

Yes, I own a home-based business

No

Please provide your business’ full address. (Follow the examples exactly. No PO Box numbers. This is only used to identify demand for broadband services.)

Street address (example: 555 Main St.) *

City (example: Springfield) *

Zip Code (5 digits only, example: 23456) *

Does this business subscribe to the Internet?

How does this business connect to the Internet?

Describe "other" below:

How important is the Internet to your business operations?

Very Important

Somewhat Important

Not Important

Please rate your business Internet service.

Meets my needs

Does NOT meet my needs

What is the primary reason your business Internet service does NOT meet your needs?

Describe "other" below:

If your business does not subscribe to an Internet service, why not?

Describe "other" below:

If an affordable, faster Internet option were offered to your business, would you be willing to commit to a year-long contract to take that service?

Yes

No

How much would you be willing to spend for faster Internet service for your business?

under $50/month

$50 - $100/month

$100 - $150/month

over $150/month

What kind of phone service does your business rely on most?

Landline

Cellular

Voice Over IP (VOIP)

Other

Describe "other" below:

Is your business phone service consistently reliable?

Yes

No

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Broadband Survey