Responsible Technology Use Registration
Register to participate and share your commitment to using technology responsibly.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization/School (if applicable)
Age Group
*
Please Select
Under 13
13-17
18-24
25-34
35-44
45+
How often do you use digital devices (computers, tablets, smartphones)?
*
Daily
Several times a week
Once a week
Rarely
Which types of devices do you use regularly? (Select all that apply)
*
Smartphone
Tablet
Laptop/PC
Smartwatch
Gaming Console
Other
On a scale of 1 to 5, how confident are you in identifying safe online practices?
*
Not confident
1
2
3
4
Very confident
5
1 is Not confident, 5 is Very confident
Which of the following responsible technology use practices do you regularly follow? (Select all that apply)
*
Using strong and unique passwords
Limiting screen time
Respecting others' privacy online
Verifying information before sharing
Reporting inappropriate content
Other
Please provide any suggestions or comments on promoting responsible technology use:
Signature (Please sign below to acknowledge your registration and agreement)
*
Register
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