Surge Link Subscriber Survey

ZIP / Postal Code *

How many people in your household are in each age range?This question helps us understand the type of users in households subscribed to Surge Link.

Under 5 years old *

5-18 years old *

19-24 years old *

25-44 years old *

45-64 years old *

65-74 years old *

75 years old or above *

Which category best describes you? Check all that apply. (i.e. Two or more races)White (Eg: German, Irish, English, Italian, Polish, French, etc)Hispanic, Latino or Spanish origin (Eg: Mexican or Mexican American, Puerto Rican, Cuban, Salvadoran, Dominican, Colombian, etc)Black or African American (Eg: African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian, etc)Asian (Eg: Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese, etc)American Indian or Alaska Native(Eg: Navajo nation, Blackfeet tribe, Mayan, Aztec, Native Village or Barrow Inupiat Traditional Government, Nome Eskimo Community, etc)Middle Eastern or North African (Eg: Lebanese, Iranian, Egyptian, Syrian, Moroccan, Algerian, etc)Native Hawaiian or Other Pacific Islander (Eg: Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, etc)Some other race, ethnicity or origin (Please specify below)

Specify other race

How much education have people in your household completed? Please indicate only the highest level completed for each individual.

Less than high school or equivalent (GED) *

High school degree or equivalent (GED) *

Some college *

Associate’s or Technical degree *

Bachelor’s degree *

Post-graduate (such as Master’s or Doctorate) *

Are you or anyone in your household a veteran? (Ever served in the U.S. Armed Forces, Reserves, or National Guard) *YesNoPrefer not to answer

Would you or anyone in your household be interested in taking digital skills training? *YesNo

Please indicate which of the following internet-connected devices are in use in your household. Indicate the number of each:

Computers or laptops *

Tablets (i.e., iPads, Kindles) *

Smart phones *

Smart appliances (internet enabled) *

Game consoles *

Internet enabled TV *

Other *

Do you speak a language other than English at home? *YesNo

What language? *

How well do you speak English? *Very wellWellNot wellNot at all

Why are you interested in Surge Link? Please check all that apply. *I did not have internet service beforeI am not satisfied with my current internet providerIt costs less than other optionsTech support is easy to accessFor other reasons (please specify)

Other activities *

What kind of Internet connection did you previously have at home? *Dial-upDSL (provided by landline telephone provider)Cable modem (provided by cable TV provider)Fixed Wireless (service from a tower to a small antenna on your house)CellularSatelliteFiberDo not know

Email Address *Enter your email address so we can contact you if you win! This will only be used for drawing purposes.