Sample Form for Project (WD1)  
   

Please take a moment to fill out the form below  

The information you can supply below will be kept confidential and will only be used to analyse patterns of usage and to plan enhancements and improvements to the organization.

After you have filled out the form, scroll all the way to the bottom and press the submit button.

Name
 

 

E-mail address
   
Phone
  ext.
Age
   
Gender
  Female   Male
Occupation
   
Residence
 
Address 1

Address 2
City
State
Zip
 
Which Languages/Countries are you most interested in?
 
Indonesia
Vietnam
Thailand
 Cambodia
Myanmar (Burmese)
Philippines
Lao
Klingonese
Which reptile do you prefer best?
   

For what reasons do you usually access this website? (check all boxes that apply)

 
Dictionaries
Reading
Audio
Library Collections
Culture

Test/Exercises
Teaching Material
Research
Downloading Images
Just for Fun

Did you use any languages that require special fonts?
    Yes No Maybe
How did you find the site?
   
How often do you visit this website?
   
How many times per month do you fill your car with gas?
  Don't have a car  1   3 4   5   More than 6
Rate the website?
     
What would you like to have added?
 
Additional Comments