JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Digital Citizenship Survey
Please respond to each question. When the survey has been completed, please click submit.
Sign in to Google
to save your progress.
Learn more
How much time during a 24 hour period do you spend using technology?
Less than one hour
1- 4 hours
4 - 8 hours
More than 8 hours
Clear selection
Please explain the importance of not sharing personal information while using technology? List examples of information you feel safe sharing and information that you do not feel is safe to share.
Your answer
Select all that apply when considering awareness of your digital health.
Mental Stress
Ergonomic Issues
Awkward Posture
Inadequate Lighting
Addiction
Other:
Explain what Digital Citizenship means to you.
Your answer
Briefly describe what Cyberbullying means to you.
Your answer
Which element of Digital Citizenship would you like to learn more about?
Yes
No
Digital Access
Digital Commerce
Digital Communication
Digital Etiquette
Digital Fluency
Digital Health
Digital Law
Digital Security and Privacy
Digital Rights and Responsibility
Yes
No
Digital Access
Digital Commerce
Digital Communication
Digital Etiquette
Digital Fluency
Digital Health
Digital Law
Digital Security and Privacy
Digital Rights and Responsibility
Clear selection
Which form/forms of technology do you use on a daily basis. Select all that apply.
Cell Phone
Computer
Gaming System
Other:
How do you spend your time using technology. Select all that apply.
Online Shopping
Paying Bills
Social Media
Gaming
Movies
Music
Education
Select the amount of education you have received on Digital Citizenship.
Choose
None
Minimal Amount
Fairly Educated on basic terms and meanings
Extensively Educated
Select the amount of education you have received on each element.
Very Little
Basic
Extensive
None
Digital Access
Digital Security and Privacy
Digital Health
Digital Rights and Resposibilty
Digital Law
Digital Literacy
Digital Etiquette
Digital Communication
Digital Commerce
Very Little
Basic
Extensive
None
Digital Access
Digital Security and Privacy
Digital Health
Digital Rights and Resposibilty
Digital Law
Digital Literacy
Digital Etiquette
Digital Communication
Digital Commerce
Clear selection
How often are you aware of safety when using technology?
Never
Occasionally
Sometimes
Often
Always
Would you like to become more educated on Digital Citizenship?
Yes
No
Maybe
Clear selection
How likely are you to inform others of the information you have in reference to Digital Citizenship?
1
2
3
4
5
Clear selection
Who are you most likely to educate others on Digital Citizenship?
Your answer
What location are you most likely to access your choice of technology from?
Home
School
Library
Other:
Clear selection
Why are you most likely to use the internet for work, education, or recreation?
Your answer
Do you have access to technology at home?
Yes
No
Clear selection
What types of technology do you have available at home?
Gaming System
Computer
Tablet
Phone
Other:
Select whether you have access to the following at home, school, work or all three.
Home
Work
School
Gaming System
Computer
Tablet
Phone
Other
Home
Work
School
Gaming System
Computer
Tablet
Phone
Other
Have you ever been cyberbullied or known someone who has?
Yes
No
Maybe
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
