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Rural Communities Technology Board

Public Input Survey

The purpose of this survey is to gather information about future telecommunications applications for rural communities in the San Luis Valley of Colorado. The Rural Communities Technology Board was formed to determine the feasibility of future telecommunications projects for rural areas not serviced by high speed data transmission systems. Your help is greatly needed to determine the future of such technology. All information is optional, but the more information you are able to provide the more thorough our summation will be. Thank You!


TO THE MEMBERS OF THE BOARD. THIS IS WORK IN PROGRESS. PLEASE FEEL FREE TO SUGGEST ADDITIONAL SURVEY QUESTIONS AND CATEGORIES. THERE IS A COMMENTS SECTION AT THE BOTTOM OF THIS FORM, OR YOU CAN E-MAIL DIRECTLY TO: ssheel@amigo.net


General Information

Organization Name:
Your Name:
E-Mail Address:
Street Address:
City:
State:
Zip:
Phone #:
Fax #:

Employment Information

Please select the category that best describes your business or field of employment.
Medical
Education
Small Business
Corporation
Service Related
Retail
Government
Financial Institute
Agriculture
Non-Profit

Select the most appropriate button indicating the number of employees in your organization.
1-2
3-5
6-10
10-20
more than 20

Phone Information

Who is your telephone service provider?
Who is your long distance service provider?
What is your local cost per month? $
What is your long distance cost per month? $
How many minutes per month in state?
How many minutes per month out of state?
Number of phone lines:
Cost of phone lines: $
Number of dedicated modum lines:
Cost of modum lines: $

Internet Information

Who is your internet service provider (ISP)?
What is your internet service monthly cost? $
How is your internet service delivered? (ie, phone line, satelite )$
Whats your most common connect speed?
What is your modum speed?

Meeting Information

Select the most appropriate button indicating the number of meetings you attend per year 50 miles or more from your home or office.
1-2
3-5
6-10
10-20
more than 20

Teleconferencing...

Select the most appropriate button indicating the likelyhood that you would use teleconferencing technology if the service were available.
Never
Not Likely
Somewhat Likey
Likely
Very Likely

Distance Learning...

Select the most appropriate button indicating the likelyhood that you would use distance learning technology if the service were available.
Never
Not Likely
Somewhat Likey
Likely
Very Likely

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