Community Survey Highspeed Internet Survey Rise Broadband is looking to bring high-speed Internet access to your community. To make this happen we need information from you to show the need for broadband in your community and your support for this effort. Information provided in response to the Survey is subject to Rise Broadband’s privacy practices, and no personal identifiable information will be sold or otherwise made available to third parties. Unless you provide your contact information below for future updates, Rise Broadband will not use the information provided in response to the Survey for marketing purposes or for other communications updating community members of improvements to local networks. Your answers to the Survey may be used by Rise Broadband on an aggregated basis with all other responses or used on an anonymous basis individually, in each case in connection with applications for grant funding from state and/or federal entities and otherwise elicit broad-based feedback to improve access to high-speed broadband Internet to your community and other communities across the states in which we provide services. An * indicates a required field.What town do you live in?* What county do you live in?* What state do you live in?*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingCurrent Internet service provider* How would you rate your current Internet experience?* Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied Feel free to tell us more about your current internet experience.What is your average home Internet monthly bill?* Does your current internet service prevent you from effectively working or studying from home?* Consistently a problem Often a problem Occasionally a problem Never a problem Feel free to tell us more about your current internet for working or studying.In what areas do you need broadband Internet?*Select all that apply Home School & Education Work Telemedicine / Health Monitoring Entertainment (video, gaming) Other (please specify) Other broadband need(s) How will access to reliable, high-speed Internet improve your community, business or home experience?*Do you, or does a family member, have an intellectual or developmental disability?* No Yes What impact would reliable broadband have on your life?*Speed TestPlease run a speedtest on your current internet service, this will allow us to capture data on your current level of service. Please make sure your device is connected to your internet network, rather than a mobile/cellular network.Contact InformationPlease provide your contact information if you would like future updatesName Company Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email PhonePhoneThis field is for validation purposes and should be left unchanged.
