Universal Service/Network Democracy
Survey Form
Allocation of Universal Service Subsidies

Please supply the following information to identify yourself: 
 
Name:    (Last)   (First) 

E-mail:         

Organization:   

City:                State:

Please answer each question by selecting one or more of the checkboxes provided or typing in requested information. If you answer "Other" to any of the questions given below, or if you have additional comments to make on these questions, please use the text box at the bottom of the form for your response.

1. Mechanisms: What mechanism should be used to provide Universal Service subsidies to schools and libraries? 

	 Cash Grants
	 Vouchers
	 Discounts on selected services
	 E-rate (100% discount) for schools and libraries
	 Other
2. Bona Fide Requests: What minimal justifications should a school, library or school district be required to offer in support of requests for subsidized telecommunications services? 
	 Request from Authorized Individual
	 State Approved Technology Plan
	 District Approved Technology Plan
	 Knowledge of Technology Options
	 Progress Toward Goals of Telecom Act
	 Provision of Matching Funds
	 Current Use of Network Resources
	 Educational Need
	 Need for Added Bandwidth
3. Extent: Should Universal Service subsidies extend to groups which provide educational materials or support for educational organizations, such as universities and colleges or community centers? 
	 Yes
	 No
4. Equity: How can the Universal Service Fund insure equity of access for all schools and libraries? 
	 Baseline subsidy
	 Per capita subsidies
	 Subsidies based upon population density
	 Subsidies based upon income
	 Other

Please elaborate on any of your responses to these questions as appropriate:


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