Sample Survey

You are invited to contribute to research being done for the Kitchener-Waterloo Urban Community Access Program, a Government of Canada initiative developed to provide free computer and Internet access to people.

The information provided in this survey will help us better understand the people who are using the public access workstations and learn more about their information needs. Your responses to this survey will be confidential. Results will only be used in aggregate form.

We would appreciate the information, but it is not mandatory.

Personal information contained will be used only by the KW Urban CAP project to administer the use of public Internet access workstations.

Is this your first visit to this CAP site?     

Gender:     

Age:

Postal Code for primary place of residence (if any):

Do you have access to the Internet at (please check all that apply):





What is the purpose of your visit today?
(Please check all that apply)










Any questions about the collection of this information should be directed to the Project Co-ordinator, KW Urban CAP Project at the Social Planning Council of Kitchener-Waterloo, 579-3800, e-mail access@waterlooregion.org

(Based on a form devised by Waterloo Regional Library. Revised with permission.)

Connecting the community

Project Overview

Community Access Program

Project Background

Project Partners

Goals and Objectives

Sample Acceptable Use Policy

Sample Survey

KW Urban CAP Project

Community Internet Access

KW Urban CAP Partners

Project Overview

Contact the Project