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Grade: |
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Name: (optional) |
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Gender: |
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| How many people
(including you) live in your house? |
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| How many
working computers
are there in your house? |
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| If the computer(s)
in your house is/are connected to the Internet, how is/are it/they
connected? |
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| Where is the
computer you usually work on located? |
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| How
many hours/day do you spend doing homework? (outside of school) |
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| How
many hours/day do you spend doing homework on the
computer (out of school)? |
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Check all the of the classes for which you used computers this year. |
English/LAHistoryExploratoryForeign
Lang. ScienceMathPhys.EdBusiness
Class |
| Which of the
following do you usually use the computer for the most when using it to
complete your homework? |
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| How many hours/day
do you spend watching TV? |
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| Which of the
following do you own/use regularly (Check all that apply): |
MP3 player (iPod, other)
Cell phone
Walkman/CD player
Gameboy
XBox/Playstation
PDA (Palm, Pocket PC)
Video
camera
Digital camera
Other, specify: |
| How many hours/day
do you spend on the computer doing NON school work? |
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| How
would you rate your overall ability to use technology? |
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What programs are you familiar with? |
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Microsoft Excel |
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Microsoft PowerPoint |
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Microsoft Word |
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Microsoft Moviemaker |
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Hyperstudio |
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Inspiration |
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Kidspiration |
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| What other types
of activities do you use the computer for (check all that apply): |
Instant Messaging
E-Mail
Gaming
Internet
research - CD Rom, Internet
Manipulating
digital pictures
Downloading
music/videos
Blogging
Pod casting
Wordprocessing
(Using Microsoft Word)
Creating multimedia
(Using PowerPoint, etc)
Taking online polls
Shopping
Other: |
| Are
you a registered user on any websites? |
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| How
do you receive information from this site? |
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What types of sites are you registered with? |
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| Do
you have your own web page? (My Space) |
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| Do
you have your own blog? |
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| Do you belong to
any listservs? |
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| Which listservs do
you belong to? (specify) |
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| Do you use your
cell phone to send text messages to friends? |
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| Do you participate
in text message voting? (i.e. American Idol, etc.) |
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| Do you regularly
communicate with people whom you have only met online? |
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If yes, what do you communicate about? |
Music, Movies, etc.
Arrange Meetings
Personal Information
- Password, etc
To Bully or Threaten
Someone
Other: |
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Please identify the following: |
LOL
PAW
POS
ASL |
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Have you ever pretended to be someone else
online? |
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Who did you pretend to be?
Your friend, someone older, younger, etc.? |
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