Application & Media surveyYou don’t have to complete this survey to apply, but if you don’t please make sure you answer the general and application questions one way or another in your application to us about “Who you are”.

Please mark/ highlight all the boxes that apply to you

GENERAL QUESTIONS

Age

Below 16 yrs 16-18 yrs 18-21 yrs 21-25 yrs Above 25 yrs

Are you …

in employment (full-time)

in employment (part-time)

unemployed self-employed

in education (full-time)

in education (part-time)

Other: ________

When was the last time you attended a course?

This year Last year 2008/2007 Over 3 years ago

What area do you live in?

Tulse Hill Dulwich

Brixton Herne Hill

Streatham Other: ________

Norwood

APPLICATION QUESTIONS

Who are you?

[Write as much as you like, or video it, send us a picture etc.]

Why do you want to be on the course?

[Write as much as you like, or video it, send us a picture etc.]

What is the biggest challenge your local community is facing?

[Write as much as you like, or video it, send us a picture etc.]

MEDIA SURVEY

What kind of mobile do you use? Samsung Nokia Motorola Blackberry LG iPhone SonyEricsson Other: ________

Do you use the internet on your mobile phone? Never Very rarely Twice a month Every week Every day Every hour Other: ________

I use the internet on my phone to check Email Facebook Download music IM Shopping Directions Other: ________

How did you find out about Apps for Good? Friends Flyer Youth centre Youth Worker School/College Connexions Facebook Other: ________

What printed magazines and newspapers do you read?

______________________________________________________________________________________________________

How often do you read them? Daily Weekly Every other week Monthly

What websites or online news sites do you read? How often?

______________________________________________________________________________________________________

Which blogs, chat rooms or forums do you read and comment on?

______________________________________________________________________________________________________

How often do you use the different networks?

Several times a day Once a day Several times a week Once a week Every other weekFacebookTwitterBeboYouTubeVimeoNING

If you wanted to spread the word about Apps For Good, how would you do it?

______________________________________________________________________________________________________

About You

Name______________________ Email Address_______________________ Phone number ________________