1. Age:
2. Gender:
3. Racial/Ethnic Identity (Check all that apply):
4. Current Situation:
1. On average, how many hours a week do you spend on computers:
2. On average, how many hours a week do you spend on the Internet?
Section 2: Attitudes
Section 3: Behaviors
Please check any of the acts or behaviors that you have engaged in:
If there anything else that you would like to share about your frustration with computers and your aggressive behavior, please type in the box below: