SeniorNet Volunteer Questionnaire (please print)

Name:___________________________________________________________________

Street Address:____________________________________________________________

City: ________________________     State: _____    Zip Code: ______________

Phone: _______________        Fax:  __________________

Best time to call: ___________________________________________________________

E-mail:   ______________________

Mail preference:      Postal                E-mail                    no preference

What operating system do you have installed at home?    Windows 95    Windows 98   

Windows Millenium   Windows XP     Linux   Windows Vista

How often do you use your system?

    Daily            2 - 3 times a week               once a week            never

For what do you use your system? (Check all that apply)

[Optional]: List below other community involvements to help us get to know you better

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