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2. The following survey is intended to provide the City of Fairview with a better understanding of which residents needs what digital resources in its community. Please share this survey with other Fairview residents and if you or someone you know needs assistance filling it out, please contact the survey administrator by emailing midgleyn@ci.fairview.or.us or calling (503) 674-6236.
4. Internet Access & Affordability Questions
6. 1. Do you currently own a device other than a cell phone (i.e. computer or tablet) that is able to access the internet?

   1. Yes
   2. No
8. 2. Do you currently have broadband internet service at your home?

   1. Yes
   2. No
10. 3. Has cost ever been a factor in whether you have decided to pay for internet services?

    1. Yes
    2. No
12. 4. How might the City of Fairview structure future digital assistance efforts to best impact community need?
14. 5. If you would like to receive information on the City of Fairview Digital Assistance Pilot Program please leave your contact information here:
18. Demographic Questions
20. 6. Are you a current Fairview resident?

    1. Yes
    2. No
22. 7. How big is your household?

    1. 1
    2. 2
    3. 3
    4. 4
    5. 5+
24. 8. Do you have children?

    1. Yes
    2. No
26. 9. What is your household’s income?

    1. Unemployed / Desempleados
    2. Lost a job / Perdí un trabajo
    3. < $1,000 per month / por mes
    4. $1,000 - $1,500 per month / por mes
    5. $1,500 - $2,000 per month / por mes
    6. $2,000 - $2,800 per month / por mes
    7. $2,800 - $3,500 per month / por mes
    8. $3,500 - $4,500 per month / por mes
    9. > $4,500 per month / por mes
28. 10. What is your race?

    1. White
    2. Black
    3. Latino
    4. Asian
    5. Native American or Alaska Native
    6. Native Hawaiian or Pacific Islander
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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