Please select one:
Parent Student

How many hours do you spend on the Internet (for any reason: sufing, shopping, research, email,etc.) per week?

<1
1-5
6-10
11-15
16-20
20+

Please read the statement and choose an answer from the drop down box.
The Government has the right to make laws controlling access to the Internet.

The Government has the right to filter/censor information on the Internet in interest of national security.


 

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<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">&lt;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>