<html>
<head>
<title>Form</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
</head>
<body >
<form action="/cgi-bin/forms/feedback.cgi" method="post" name="Form" id="Form">
<input name="$NDmethod" type="hidden" value="e-mail">
<p align="center"><font size="2" face="Arial,
Helvetica, sans-serif">
Please select one:</font><font face="Arial, Helvetica, sans-serif"><br>
<input type="radio" name="radiobutton" value="P">
Parent
<input type="radio" name="radiobutton" value="S">
Student</font></p>
<p align="center"><font face="Arial, Helvetica, sans-serif">
How many <b>hours</b> do you spend on the Internet (for any reason:
sufing, shopping, research,
email,etc.) <b>per week</b>?</font></p>
<div align="center">
<table border="1" cellpadding="2" width="400">
<tr>
<td width="50" height="16"> <div align="center"><font
face="Arial, Helvetica, sans-serif"><1</font></div></td>
<td width="50" height="16"> <div align="center"><font
face="Arial, Helvetica, sans-serif">1-5</font></div></td>
<td width="50" height="16"> <div align="center"><font
face="Arial, Helvetica, sans-serif">6-10</font></div></td>
<td width="50" height="16"> <div align="center"><font
face="Arial, Helvetica, sans-serif">11-15</font></div></td>
<td width="50" height="16"> <div align="center"><font
face="Arial, Helvetica, sans-serif">16-20</font></div></td>
<td width="50" height="16"> <div align="center"><font
face="Arial, Helvetica, sans-serif">20+</font></div></td>
</tr>
<tr>
<td width="50"> <div align="center"> <font
face="Arial, Helvetica, sans-serif">
<input type="radio" name="hours" value="1">
</font></div></td>
<td width="50"> <div align="center"> <font
face="Arial, Helvetica, sans-serif">
<input type="radio" name="hours" value="2">
</font></div></td>
<td width="50"> <div align="center"> <font
face="Arial, Helvetica, sans-serif">
<input type="radio" name="hours" value="3">
</font></div></td>
<td width="50"> <div align="center"> <font
face="Arial, Helvetica, sans-serif">
<input type="radio" name="hours" value="4">
</font></div></td>
<td width="50"> <div align="center"> <font
face="Arial, Helvetica, sans-serif">
<input type="radio" name="hours" value="5">
</font></div></td>
<td width="50"> <div align="center"> <font
face="Arial, Helvetica, sans-serif">
<input type="radio" name="hours" value="6">
</font></div></td>
</tr>
</table>
</div>
<p align="center"><font size="2" face="Arial,
Helvetica, sans-serif">Please
read the statement and choose an answer from the drop down box.</font><font
face="Arial, Helvetica, sans-serif"><br>
The Government has the right to make laws controlling access to the Internet.<br>
<select name="make">
<option value="#" selected>Please Choose</option>
<option value="agree">Agree</option>
<option value="disagree">Disagree</option>
<option value="dontknow">Don't Know</option>
</select>
</font></p>
<p align="center"><font face="Arial, Helvetica, sans-serif">The
Government has
the right to filter/censor information on the Internet in interest of national
security.
<select name="filter" id="filter">
<option value="#" selected>Please Choose</option>
<option value="agree">Agree</option>
<option value="disagree">Disagree</option>
<option value="dontknow">Don't Know</option>
</select>
</font></p>
<p align="center">
<input type="submit" name="Submit" value="Submit">
</p>
<p align="center">
<input type="reset" name="Submit2" value="Reset">
<br>
</p>
</form>
</body>
</html>