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Subscriber Survey
The following information will be used to help us understand the audience for distance education courses and programs.
The information you provide will be kept confidential. We will not share or sell your information to any other organization.
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First Name:
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Last Name:
Phone Number:
Address:
County (only if you reside in Indiana):
Select A County
Adams
Allen
Bartholomew
Benton
Blackford
Boone
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Clinton
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Elkhart
Fayette
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Fountain
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Grant
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Hamilton
Hancock
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Hendricks
Henry
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Jackson
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Jay
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Johnson
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Martin
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Ohio
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Pulaski
Putnam
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Rush
Scott
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Spencer
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Starke
Steuben
Sullivan
Switzerland
Tippecanoe
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Union
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Wabash
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Washington
Wayne
Wells
White
Whitley
City:
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State (only if you reside in the USA):
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Alabama
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California
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District of Columbia
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Tennessee
Texas
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Vermont
Virginia
Washington
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Wyoming
Zip Code:
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Country (only if you reside outside the USA):
Select A Country
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Aruba
Armenia
Ascension Island
Australia
Austria
Azerbaijan
Bangladesh
Bahamas
Bahrain
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cap Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia/Hrvatska
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvina)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See (City Vatican State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, Former Yugoslav Republic
Madagascar
Malawi
Malaysia
Mali
Maldives
Marshall Islands
Malta
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federal State of
Moldova, Republic of
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territories
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Reunion Island
Romania
Russian Federation
Rwanda
St. Helena
St. Pierre and Miquelon
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (USA)
Wallis and Futuna Islands
Western Sahara
Western Samoa
Yemen
Yugoslavia
Zimbabwe
Zambia
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Year you were born:
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Gender:
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Female
The program I use to read my e-mail is:
Highest level of education:
Select Education
High School
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
Other
if other:
Reason you are interested in distance education:
Are you currently, or have you ever, taken a distance education class?
Yes
No
Are you degree seeking?
Yes
No