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First Name:
Last Name:
Phone:
Alt Phone:
Street:
City:
Email:
How Long Have you been using computers?
Less Than 6 months
6 Months to 1 Year
1 Years
2 Years
3 to 5 Years
More than 5 Years
Computer Experience Level:
1
2
3
4
5
6
7
8
9
10
What Version Of Windows do you primarily use?
Windows 3.1
Windows 95
Windows 98
Windows ME
Windows 2000
Windows XP
Other
Have you taken classes before?
YES
NO
What is you Age group?
Under 16
16 - 20
21 - 25
26 - 30
31 - 35
36 - 40
41 - 45
46 - 50
51 - 55
56 - 60
61 - 70
Over 70
How often do you use the internet?
Everyday
Few times a week
Every Week
Every Month
Top 5 Learning Points of Interest:
1. 2. 3. 4. 5.
