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* 1. Community Name:
(Please use the name of the Municipality in which you reside and receive a tax bill from or First Nation Community)

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* 2. What is your street address? (i.e. 123 John St.)

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* 3. Please indicate the most appropriate description for your location:

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* 4. Have you/will you conduct a speed test through the CIRA/Connectednorth.ca partnership speed test portal?
(Click this link to take the speed test).

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* 5. If you receive high speed internet, what method do you use to receive your service? (If you are not certain what type of internet you have, click here to learn more about the different types of internet delivery).

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* 6. If you receive high speed internet, are you satisfied with your service?

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* 7. Please specify what type of activities you and your family would, or do access on line:

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* 8. Delivering broadband to urban communities is typically easier and less expensive than delivering the same service in rural communities, therefore rural customers tend to absorb some of those costs.

If a new service became available to you that could consistently deliver 50Mbps down and 10 Mbps up and had no monthly data restrictions, how much more per month would you be willing to spend for this service:

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* 9. Do you believe advanced communications services to be important for the community, inhabitants and businesses?

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* 10. What is the single most important criteria for your internet connection:

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* 11. In the recent past, many of these services didn’t even exist yet today we view them as nearly indispensable. Please assign a rank of importance to the following utilities/services/goods that you likely pay for each month:

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* 12. Any additional comments?

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