Here is the Internet Habits and Uses template.

How comfortable do you feel using the Internet?

Very comfortable
Somewhat comfortable
Neither comfortable nor uncomfortable
Somewhat uncomfortable
Very uncomfortable

How satisfied are you with your current skills for using the Internet?
Very satisfied - I can do everything that I want to do
Somewhat satisfied - I can do most things I want to do
Neither satisfied nor unsatisfied
Somewhat unsatisfied - I can't do many things I would like to do
Very unsatisfied - I can't do most things I would like to do

How comfortable do you feel using computers, in general?

Very comfortable
Somewhat comfortable
Neither comfortable nor uncomfortable
Somewhat uncomfortable
Very uncomfortable

Some websites ask for you to register with the site by providing personal
information. What percent of the time do you enter false information when
asked to register?
Rather not say
I've never falsified information
Under 25% of the time

26 - 50% of the time

51 - 75% of the time
Over 75% of the time
I've never registered with a site

Why don't you purchase more products and services on the web, either for
yourself or for your work/business? (Please check all that apply)
Not applicable
Never tried it
Too complicated to place order
Faster/easier to purchase locally
Not familiar with vendor
Don't trust that my credit card number will be secure
No receipt/documentation
Difficult to judge the quality of a product/service
Not enough information to make a decision
Generally uncomfortable with the idea
Other

In your opinion, what is the single most critical issue facing the Internet?

Finding things/navigating around

Speed/bandwidth
Government regulation
Equal access for all
Pornography
Internet crime (e.g. hatecrimes, stalking)
Paying for online services or information
Censorship
Privacy
Other

Which of these groups have you become more connected to through the
Internet? (Please check all that apply.)
None
People who share my political interests
People who share my hobbies/recreational activities
People who share my religion
People in my profession
People in my family
People in similar life situations (e.g. self-help groups, support groups)
Other groups

Complete the following sentence in the way that comes closest to your own
views: "Since getting on the Internet, I have "
become MORE connected with people like me.
become LESS connected with people like me.
Don't know/can't say

Which of the following have you done? Please check all that apply.
Ordered a product/service from a business, government or educational entity by filling out
a form on the web
Made a purchase online for more than $100
Created a web page
Customized a web page for yourself (e.g. My Yahoo, CNN Customer News)
Changed your browser's "startup" or "home" page
Changed your "cookie" preferences
Participated in an online chat or discussion (not including e-mail)
Listened to a radio broadcast online
Made a telephone call online
Used a nationwide online directory to find an address or telephone number
Taken a seminar or class about the Web or Internet
Bought a book to learn more about the Web or Internet

Advantages

Low costs.
Automation and real-time access.
Less time. Rapid deployment and return times are possible with online surveys that
cannot be attained by traditional methods.
Convenience for respondents. They can answer questions on their schedule, at their
pace, and can even start a survey at one time, stop, and complete it later.
Design flexibility. Surveys can be programmed even if they are very complex.

No interviewer. Interviewers can also influence responses in some cases.

Disadvantages

Limited sampling and respondent availability. Certain populations are less likely to
have internet access and to respond to online questionnaires. It is also harder to draw
probability samples based on e-mail addresses or website visitations.

Possible cooperation problems. Although online surveys in many fields can attain
response rates equal to or slightly higher than that of traditional modes, internet users
today are constantly bombarded by messages and can easily delete your advances.

No interviewer. A lack of a trained interviewer to clarify and probe can possibly lead
to less reliable data.