First Name  

Grade

1. Do you have a computer at your house? Yes No

2. Are you allowed to use it? Yes No Sometimes

3. Are you allowed to use the computer as often as you like? Yes     No 

4.  How often do you use the computer?

 30 minutes/day 

 1-3 hours/day

 1-3 hours/week

 Not very often

5. What kind of things do you like to do on the computer?

 Play video games

E-mail and instant message my friends and family.

Look up things on the Internet

Download music.

My Space or Face Book

Other

6. What computer games do you like?

6b. What is your favorite website?

7. What would you like to learn to do on the computer? I would like to learn to

8. Can you type? Yes     No    A little bit

9. Do your parents use a computer at work? Yes   No

10. How?

11. Name 3 ways that you could use a computer to learn in school.

I use the computer in school to...