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Page One

1. Name of school

2. Location (city, state, ZIP)

3. Adviser contact information (optional)

Name
Email

4. Type of student media checking Internet filtering(check as many as apply)

5. Name(s) of participating student media

6. Name of sites blocked, URL, topic searched for when blocked. Name all you checked that were blocked.

7. Was one side of an issue or event blocked and another viewpoint permitted? Explain.

8. Brief annotation of educational value/goals/mission of the information you tried to obtain.

9. Other comment or information you feel might be helpful, like interviews with students who have been blocked or other information related to the subject.

10. Can Internet filters be lifted at your school for any class purposes?

Comment

11. Who, if anyone, has the authority to remove the filters?

12. Can Internet filters be lifted at your school for journalism (class or publication) purposes?

Comment

13. Who, if anyone, has the authority to remove the filters?

14. Talk with IT people to gather information about your Internet filters (name, manufacturer, categories the filter is designed to block, cost to the system and can the categories filtered by altered by the school system)

15. Statement of adviser/students about the experience and what you found. Could relate to previous experience with Internet filters.

16. Other comments about Internet filtering or this survey you wish to make