Date:____________________
Name _______________________
Home Phone__________________
Work Phone__________________
E-mail_______________________

1.   Do you have access to a computer at work ____ yes
                                                                           ____ no
                                                             at home ____ yes
                                                                           ____ no

2.  If you have access to a work computer, can you use the computer to do schoolwork?
      yes_________  no_______

3.  What type of computer(s) do you have access (check all that apply)?
 
       ________ PC      ________ at home _______at work
       ________MAC   ________ at home _______at work
       ________Networked  ____ at home _______at work

4.  Does the computer have a modem?
 
      home_____ yes ______ no  ______ I don’t know.
      work _____yes _______no  ______ I don’t know.
 
5.  If yes, what speed is your modem?
 
     _______    9,600 bps
     _______ 14, 400 bps
     _______  28,800 bps
     _______  other_______________
     _______  I don’t know.

6.   Do you have email access?

     home_____ yes ______ no
     work _____yes _______no

7.   Do you have a university e-mail account?  _____ yes  _____ no

8.   Do you use e-mail?  _____ yes  ______ no
 
      If yes, how often?________________________________________________

9.   Have you had any e-mail training?  ______ yes ______ no
 
       If yes, where?___________________________________________________
 
      What type of training?_____________________________________________

10.  Do you know what a listserv is? ______ yes ______ no

11.  Do you know how to subscribe to a listserv?  _____ yes _____ no

12.  Do you currently subscribe to any professional listservs? _____ yes _____ no
 
       If yes, which listservs?__________________________________________________

13.  Have you ever participated in a computer mediated training activity?
      _______ yes _______ no

      If yes, who gave  the training?____________________________________________
 
      What was the training? _________________________________________________
 
      How did the training use computers?  ______________________________________
     _____________________________________________________________________
     _____________________________________________________________________

14.  Do you have anything else you would like to add? ________________________________________________________________________

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