Web Demographics Survey Template

Web demographics survey including assessment of resources needed by impaired.



   
 
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 posting on a newsgroup
 
Guessed the URL address
 
Was told URL by friend
 
Read about it in a newspaper/magazine
 
Remembered to participate from the last survey
 
Don't remember
 
Other
    

 
   
 
How long have you been using the Internet (including using e-mail, gopher, ftp, etc.)?
 
Less than 6 months
 
6 to 12 months
 
1 to 3 years
 
4 to 6 years
 
7 years or more
 
   
 
What is your primary language (i.e., the one you speak most of the time)?

 
English
 
Spanish
 
Chinese
 
French
 
German
 
Dutch
 
Japanese
 
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
 
Not impaired

 
   
How frequently do you access the internet from the following places?
Daily Weekly Monthly Less than
once a month
Never Can't say
Home
Work
School
Cyber café
Other
 
   
 
Who pays for your Internet access? (Please check all that apply.)
 
Self/spouse
 
Parents
 
Work
 
School
 
Don't know
 
Other
    
 
   
 
Are you currently registered to vote?
 
Rather not say
 
No
 
Yes
 
Not applicable
 
   
What type of industry do you work in (e.g. software, government, IT etc)?
   
 
   
 
Which of the following best describes your role in industry?
 
Upper Management
 
Middle Management
 
Junior Management
 
Administrative Staff
 
Support Staff
 
Student
 
   
 
The organization you work for comes under which of the following categories?
 
Public sector (e.g. government)
 
Private sector (e.g. most businesses and individuals)
 
Not-for-profit sector
 
Do not know
 
Other
    
 
   
 
What is your organization's total budget for this year, from all sources?
 
less than $1 million (US)
 
$1 million to $10 million (US)
 
$10 million to $100 million (US)
 
$100 million to $500 million (US)
 
$500 million to $1 billion (US)
 
over $1 billion (US)
 
Do not know
 
Rather not say
 
   
 
During an average week, most of your professional correspondence (postal mail or e-mail) is with which of the following:

 
Public sector (e.g. government)
 
Private sector (e.g. most businesses and individuals)
 
Not-for-profit sector
 
Do not know
 
Other
    
 
   
 
Please indicate which of the following are sources of revenue for your organization: (Please check all that apply.)
 
Sales to individuals or private organizations (but not contracts)
 
Sale to government organizations (but not contracts)
 
Contracts to do work for private organizations
 
Contracts to do work for government organizations
 
Contracts to do work for other organizations
 
Government appropriations
 
User charges and fees
 
Donations
 
Don't know
 
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
 
   
 
Note: Although this is a sensitive question, the answer can help Internet developers to understand the needs of current web users. It is not intended to offend.
How would you classify yourself?
 
Rather not say
 
Caucasian/White
 
African American
 
Indigenous or Aboriginal Person
 
Asian/Pacific Islander
 
Hispanic
 
Latino
 
Multiracial
 
Other
    
 
   
 
What is your current marital status?
 
Rather not say
 
Divorced
 
Living with another
 
Married
 
Separated
 
Single
 
Widowed
 
   
 
Where are you located?
 
Africa
 
Antarctica
 
Asia
 
Oceania (Australia, New Zealand, etc.)
 
Europe
 
USA
 
Canada
 
Mexico
 
Central America
 
South America
 
Other
    
 
   
 
Which of the following best describes the area you live in?
 
Urban
 
Suburban
 
Rural
 
   
 
How many children under 16 years old live in your household?
 
None
 
1
 
2
 
3
 
4 or more
 
   
 
Please indicate your current household income in U.S. dollars
 
Rather not say
 
Under $10,000
 
$10,000 - $19,999
 
$20,000 - $29,999
 
$30,000 - $39,999
 
$40,000 - $49,999
 
$50,000 - $74,999
 
$75,000 - $99,999
 
$100,000 - $150,000
 
Over $150,000
 
   
What is your age?
   
 
   
 
What is your primary computing platform?
 
Windows
 
Macintosh
 
Linux
 
Unix
 
Other
    
 

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