Focus Groups (PAC users)

Institute of Museum and Library Services

University of Washington Information School

The Impact of Free Access to Computers and the Internet in Public Libraries

Demographic Information Sheet for Focus Group Public Library Users

This is an information sheet asking information specific to you. Please take a moment to fill it out. We are asking that you pick an Alias or an anonymous name for yourself that we will use instead of your real name. This information is confidential except as provided by law. Providing the information is voluntary. If you are not comfortable providing this information for our study, you do not have to. Thank you.

Alias:______________________ Library:____________________

Date:______________________

Demographic Questions

1. What is your zip code? _____________________

2. What year were you born? ____________________

3. How many family members are living or staying in your home? Include married spouses, children by birth or adoption, and blood relatives. ____________________

4. Do you speak a language other than English at home? (Check one)

_______ Yes _______ No

[If yes] What languages do you speak at home? ___________________________

5. What type of home do you live in? (Check one)

_____Mobile home

_____ One-family house detached from any other house

_____ One-family house attached to one or more houses

_____ Building with 2 or more apartments

_____ Boat, RV, van, etc.

_____ Currently homeless

6. Thinking about all the different sources of income your family received in 2008, what was the combined total income from all sources before taxes and other deductions? Your best estimate is fine.

$_______________________

7. In the last 2 weeks, did you work for pay at a job or business? (Check one)

_______ Yes _______ No

1. [If yes] Are you working full-time or part-time? (Check one)

_______ Full-time _______ Part-time

2. [If no] Are you looking for work? (Check one)

_______ Yes _______ No

8. What is the highest level of education you’ve completed? Check one of the following:

_____Grade school

_____Some high school

_____High school or GED

_____Some college

_____2 year degree or vocational school

_____4 year degree

_____Post graduate study

9. Are you of Hispanic, Latino, or Spanish origin? (Check one)

_______ Yes _______ No

10. What race do you most identify with? You can check more than one.

_____American Indian or Alaska Native

_____Asian

_____Black or African American

_____Native Hawaiian or other Pacific Islander

_____White

11. What is your gender?(Check one)

____Female

____Male

Demographic Information Sheet for Public Library User Focus Group MLS | 2