Teenager Technology Survey

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* 1. Full Name

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* 2. E-Mail Address

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* 3. Phone number to reach you

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* 4. What is your age?

Less than 13 years old

13-15 years old

16-18 years old

More than 18 years old (please specify):

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* 5. What is your gender?

Female

Male

Prefer not to say

Other:

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* 6. Where do you live?

City

State

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* 7. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)