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+\documentclass{article}
+%
+% AcroTeX eDucation Bundle required for the email option.
+%
+\usepackage[email,coverpage,forcolorpaper,nopoints,nosolutions,useforms]{eqexam}
+
+\title[TS]{\texorpdfstring{\TeX}{\textbackslash TeX} Usage Survey}
+\author{D. P. Story}
+\subject{\texorpdfstring{\sffamily eqExam}{eqExam} Demo}
+\date{Spring, \the\year}
+\keywords{TeX Usage Survey, eqExam, AcroTeX}
+
+\university
+{%
+ THE UNIVERSITY OF AKRON\\
+ Theoretical and Applied Mathematics
+}
+\email{dpstory@uakron.edu}
+
+\EmailSubject{TeX/LaTeX Survey Results}
+\EmailCourseName{eqExam Demo}
+\EmailExamName{TeX Usage Survey}
+\ServerRetnMsg{Your TeX survey results have been received, thank you.}
+\SubmitInfo{http://myWebSite/scripts/eqAttach.asp?nopath\#FDF}{myname@mymailprovider}
+
+\lhead{\textsf{eqExam} Demo}
+\rhead{\TeX{} Usage Survey}
+
+\renewcommand\maketitledesign
+{%
+ \parbox{\textwidth}{\normalsize
+ \makebox[\textwidth][c]{\bfseries\sffamily\Large\webtitle}\\[3ex]
+ \makebox[\textwidth][s]{An \textsf{eqExam} Demo \hfill\webauthor}}
+}
+\makeatletter
+\renewcommand\eqexcoverpagedesign
+{%
+ \thispagestyle{empty}
+ \addtolength\textwidth{\oddsidemargin}
+ \vspace*{.1\textheight}
+ \noindent\hspace*{-\oddsidemargin}%
+ \makebox[\linewidth]{\parbox{\linewidth}%
+ {\bfseries\color{blue}\large\centering\webuniversity}}
+ \par\vspace{.1\textheight}
+ \noindent\hspace*{-\oddsidemargin}%
+ \makebox[\linewidth]{\parbox{\linewidth}%
+ {\bfseries\color{blue}\large\centering\websubject}}
+ \par\vspace{\bigskipamount}
+ \noindent\hspace*{-\oddsidemargin}%
+ \makebox[\linewidth]{\parbox{\linewidth}%
+ {\bfseries\color{blue}\large\centering\webtitle}}
+ \par\vfill
+ \optionalpagematter
+ \par\vfill
+ \parindent0pt
+ \@date
+}
+\makeatother
+
+%
+% From the Web package, part of the AcroTeX eDucation Bundle
+%
+\newNaviIcon[j]{\GoToSubmit}{20pt}{15pt}{\textcolor{webblue}{$\blacktriangleleft$}}{this.pageNum=1}
+\def\optionalpagematter
+{%
+ \begin{center}\setlength{\fboxrule}{1pt}
+ \fcolorbox{blue}{webyellow}{%
+ \begin{minipage}{.67\linewidth}
+ \noindent\textcolor{red}{\textbf{Instructions:}} First, thank
+ you very much for taking the time to fill out this survey of
+ \TeX/\LaTeX{} usage. I will summarize the results, and make
+ them publicly available. The survey has not been commissioned
+ by TUG ({\TeX} User's Group), but is a demo of some of
+ capabilities of my new {\LaTeX} package
+ \textsf{eqExam}.\par\medskip When you have finished, click on
+ the ``Submit'' button to record your responses.\par\medskip
+ \textbf{\textcolor{red}{Note:}} The \textcolor{webblue}{Adobe
+ Reader}, or an \textcolor{webblue}{Acrobat} application
+ (version 5.0 or later) is required to submit this
+ survey.\hfill\mbox{D. P. Story}
+ \end{minipage}}
+ \end{center}
+}
+
+\begin{document}
+
+\maketitle
+
+\begin{exam}{Part1}
+
+\begin{instructions}[\TeX/\LaTeX.]
+This first block of questions concerns your use of {\TeX/\LaTeX}.
+\end{instructions}
+
+\begin{problem*}
+Experience using \TeX/\LaTeX.
+\begin{parts}
+\item How would you describe yourself in terms of experience using \TeX/\LaTeX?
+\begin{answers}{4}
+\rowsep{1bp}
+\bChoices
+ \Ans0 Novice\eAns
+ \Ans0 Intermediate\eAns
+ \Ans0 Experienced\eAns
+ \Ans0 Package Developer\eAns
+\eChoices
+\end{answers}
+
+\item I have used \TeX/\LaTeX{} for\dots
+\begin{answers}{3}
+\rowsep{1bp}
+\bChoices
+ \Ans0 less than a year\eAns
+ \Ans0 one to two years\eAns
+ \Ans0 two to five years\eAns
+ \Ans0 five to ten years\eAns
+ \Ans0 ten to fifteen years\eAns
+ \Ans0 fifteen to twenty years\eAns
+ \Ans0 more than twenty years\eAns
+\eChoices
+\end{answers}
+
+\end{parts}
+\end{problem*}
+
+\begin{problem}
+Approximately how many hours do you spend using \TeX/\LaTeX{} in a typical week?
+On a per week basis, I use \TeX/\LaTeX\dots
+\begin{answers}{4}
+\rowsep{1bp}
+\bChoices
+ \Ans0 less than an hour\eAns
+ \Ans0 one to two hours\eAns
+ \Ans0 three to five hours\eAns
+ \Ans0 ten hours\eAns
+ \Ans0 more than ten hours\eAns
+\eChoices
+\end{answers}
+\end{problem}
+
+\begin{problem}
+There are many {\TeX} user's groups worldwide, are you a member of one or more?
+\begin{answers}{4}
+\bChoices
+ \Ans0 Yes\eAns
+ \Ans0 No\eAns
+\eChoices
+\end{answers}
+\end{problem}
+
+\begin{problem*}
+The following questions concern your preferred use of \TeX.
+\begin{parts}
+\item\label{whichTeX} Which styles to you predominately use?
+\begin{answers}{4}
+\rowsep{1bp}
+\bChoices[2]
+ \Ans0 Plain \TeX\eAns
+ \Ans0 \LaTeX\eAns
+ \Ans0 Con\TeX t\eAns
+ \Ans0 Other, \makebox[0pt][l]{please specify \fillin{1.25in}{\empty}}\eAns
+\eChoices
+\end{answers}
+
+\item Based on your response to \hyperref[whichTeX]{(\ref*{whichTeX})},
+please explain why you made the choice you did.
+\begin{solution}[.75in]
+\end{solution}
+
+
+\item There are many {\TeX} Systems available for use, commercial,
+shareware, freeware. Which one do you primarily use?
+\begin{answers}{4}
+\rowsep{1bp}
+\bChoices
+ \Ans0 A \TeX{} Live System\eAns
+ \Ans0 te\TeX\eAns
+ \Ans0 Mik\TeX\eAns
+ \Ans0 PC\TeX\eAns
+ \Ans0 Y\negthinspace{\scriptsize\&}\negthinspace Y \TeX{} System\eAns
+ \Ans0 Textures\eAns
+ \Ans0 CMac\TeX\eAns
+ \Ans0 True\TeX\eAns
+ \Ans0 Oz\TeX\eAns
+ \Ans0 Other, \makebox[0pt][l]{please specify \fillin{1.75in}{\empty}}\eAns
+\eChoices
+\end{answers}
+
+\item What is your favorite {\TeX} editor? Specify \fillin{1.75in}{\empty}
+
+\end{parts}
+\end{problem*}
+
+\begin{problem*}
+What operating systems (OS) do you use \TeX?
+
+\setlength\columnseprule{0pt}
+
+\begin{parts}
+
+\item What operating system (OS) runs on the machine you
+most frequently use when working with \TeX/\LaTeX? Select one.
+\begin{multicols}{2}
+\begin{answers}{1}
+\bChoices
+ \Ans0 Windows XP\eAns
+ \Ans0 Windows ME\eAns
+ \Ans0 Windows NT\eAns
+ \Ans0 Windows 2000\eAns
+ \Ans0 Windows 98\eAns
+ \Ans0 Windows 95\eAns
+ \Ans0 Macintosh OS X\eAns
+ \Ans0 Macintosh OS 9\eAns
+ \Ans0 Macintosh OS 8\eAns
+ \Ans0 Macintosh OS 7 or earlier\eAns
+ \Ans0 Unix or Linux\eAns
+ \Ans0 Other, please specify \fillin{1.25in}{\empty}\eAns
+ \Ans0 Don't know\eAns
+\eChoices
+\end{answers}
+\end{multicols}
+
+\item Some people work on multiple platforms, what is your secondary
+OS for working with \TeX/\LaTeX?
+\begin{multicols}{2}
+\begin{answers}{1}
+\bChoices
+ \Ans0 Windows XP\eAns
+ \Ans0 Windows ME\eAns
+ \Ans0 Windows NT\eAns
+ \Ans0 Windows 2000\eAns
+ \Ans0 Windows 98\eAns
+ \Ans0 Windows 95\eAns
+ \Ans0 Macintosh OS X\eAns
+ \Ans0 Macintosh OS 9\eAns
+ \Ans0 Macintosh OS 8\eAns
+ \Ans0 Macintosh OS 7 or earlier\eAns
+ \Ans0 Unix or Linux\eAns
+ \Ans0 Other, please specify \fillin{1.25in}{\empty}\eAns
+ \Ans0 Don't use two systems.\eAns
+\eChoices
+\end{answers}
+\end{multicols}
+
+\end{parts}
+
+\end{problem*}
+
+
+\begin{eqComments}[Seeking Help.]\end{eqComments}
+
+\begin{problem*}
+These questions concern any problems you may have with \TeX/\LaTeX{} and resources available to you.
+\begin{parts}
+\item Do you struggle on alone (with \TeX/\LaTeX ) if things are going wrong, or do you
+ seek help?
+ \begin{answers}{3}
+ \bChoices
+ \Ans0 Struggle on along\eAns
+ \Ans0 Seek help from a friend or colleague\eAns
+ \Ans0 Seek help from a public forum\eAns
+ \eChoices
+ \end{answers}
+
+\item Do you use on-line resources?
+ \begin{answers}{4}
+ \bChoices
+ \Ans0 No\eAns
+ \Ans0 Yes, I use \makebox[0pt][l]{\fillin{1.75in}{\empty}}\eAns
+ \eChoices
+ \end{answers}
+
+\goodbreak
+
+\item Do you seek help from \texttt{comp.text.tex}?
+ \begin{answers}{3}
+ \bChoices
+ \Ans0 No\eAns
+ \Ans0 Yes, I read the postings occasionally\eAns
+ \Ans0 Yes, I read the postings regularly\eAns
+ \Ans0 Yes, I even ask questions\eAns
+ \Ans0 Yes, I answer questions on occasion\eAns
+ \Ans0 Yes, I regularly answer questions\eAns
+ \eChoices
+ \end{answers}
+\end{parts}
+\end{problem*}
+
+\begin{problem*}
+The \textsf{CTAN} Archive.
+\begin{parts}
+\item\label{CTAN} Do you know about \textsf{CTAN} (Central {\TeX} Archive Network)?
+ \begin{answers}{4}
+ \bChoices
+ \Ans0 No\eAns
+ \Ans0 Yes\eAns
+ \eChoices
+ \end{answers}
+
+\item If you answered ``Yes'' to question~\hyperref[CTAN]{(\ref*{CTAN})}, approximately, how often
+ do you use this archive?
+ \begin{answers}{3}
+ \bChoices
+ \Ans0 Once or twice a month\eAns
+ \Ans0 three to five times per month\eAns
+ \Ans0 More than five times per month\eAns
+ \eChoices
+ \end{answers}
+
+\end{parts}
+\end{problem*}
+
+\begin{problem*}
+The {\TeX} \textsf{FAQ} Resource.
+\begin{parts}
+\item\label{FAQ} Do you know there is a {\TeX} \textsf{FAQ} online resource? (\texttt{http://www.tex.ac.uk/faq})
+ \begin{answers}{4}
+ \bChoices
+ \Ans0 No\eAns
+ \Ans0 Yes\eAns
+ \eChoices
+ \end{answers}
+
+\item\label{FAQ1} If you answered ``Yes'' to question, \hyperref[FAQ]{(\ref*{FAQ})} have you ever used the \textsf{FAQ}?
+ \begin{answers}{4}
+ \bChoices
+ \Ans0 No\eAns
+ \Ans0 Yes, \makebox[0pt][l]{how often? \fillin{1in}{\empty} per year.}\eAns
+ \eChoices
+ \end{answers}
+\end{parts}
+\end{problem*}
+
+\begin{problem}
+In terms of paper publications, what are the titles of the books you use for a reference to your
+work in \TeX/\LaTeX? Please list titles/authors in the space provided below.
+\begin{solution}[1.8in]
+\end{solution}
+\end{problem}
+
+\goodbreak
+\begin{eqComments}[Print and PDF.]\end{eqComments}
+
+\begin{problem}
+What application do you use to create PDF? Adobe Distiller, ps2pdf, other.
+\begin{answers}{3}
+\rowsep{1bp}
+ \bChoices
+ \Ans0 Adobe Distiller\eAns
+ \Ans0 \textsf{ps2pdf} (\textsf{pdfwriter})\eAns
+ \Ans0 \textsf{pdftex}\eAns
+ \Ans0 \textsf{dvipdfm}\eAns
+ \Ans0 Other, \makebox[0pt][l]{please specify \fillin{1.75in}{\empty}}\eAns
+ \eChoices
+\end{answers}
+\end{problem}
+
+\begin{problem}
+Describe the reasons you create PDF document from a \TeX/\LaTeX{} source. Is it for
+distribution over the Internet; to create interactive, high
+content materials; for business purposes? Please elaborate in the
+space provided below.
+\begin{solution}[.75in]
+\end{solution}
+\end{problem}
+
+\begin{problem}
+Do you use {\TeX/\LaTeX} primarily for creating printable documents, or for creating
+a PDF document suitable for publication on the Internet, or distribution to a colleague?
+\begin{answers}{3}
+ \bChoices
+ \Ans0 Exclusively for print\eAns
+ \Ans0 Mostly for PDF\eAns
+ \Ans0 About half and half\eAns
+ \eChoices
+\end{answers}
+\end{problem}
+
+\begin{problem}
+If you have any experience or knowledge of commercial publishing
+houses that use a \TeX/\LaTeX{} or \textsf{pdftex} work flow for
+prepress typesetting, please list publishing houses and countries
+in the space provided below.
+\begin{solution}[.75in]
+\end{solution}
+\end{problem}
+
+\begin{eqComments}[Population Demographics.]
+The next set of questions concern you.
+\end{eqComments}
+
+\begin{problem}
+My gender is \dots
+\begin{answers}{5}
+ \bChoices
+ \Ans0 Male\eAns
+ \Ans0 Female\eAns
+ \Ans0 \makebox[0pt][l]{Prefer not to disclose}\eAns
+ \eChoices
+\end{answers}
+\end{problem}
+
+\begin{problem}
+I am \fillin{.75in}{\empty} years old.
+\end{problem}
+
+\begin{problem}
+Which of the following best describes your status as
+an \TeX{} user today? Select one:
+
+\begin{answers}{1}
+ \bChoices
+ \Ans0 Use as a student\eAns
+ \Ans0 Use as an educator/trainer\eAns
+ \Ans0 Use at home for personal use or as a hobby\eAns
+ \Ans0 Use for a home-based business\eAns
+ \Ans0 Use in a company or business (non-home based)\eAns
+ \eChoices
+\end{answers}
+\end{problem}
+
+\begin{problem}
+What is your country of residence? Select one:
+
+\setlength\columnseprule{0pt}
+
+\begin{multicols}{2}
+\begin{answers}{1}
+ \bChoices
+ \Ans0 United States of America\eAns
+ \Ans0 Canada\eAns
+ \Ans0 Other Americas, \mbox{specify: \fillin{1.24in}{\empty}}\eAns
+ \Ans0 United Kingdom\eAns
+ \Ans0 France\eAns
+ \Ans0 Germany\eAns
+ \Ans0 Sweden\eAns
+ \Ans0 Netherlands\eAns
+ \Ans0 Other Europe, \mbox{specify: \fillin{1.25in}{\empty}}\eAns
+ \Ans0 Japan\eAns
+ \Ans0 Hong Kong/Taiwan\eAns
+ \Ans0 China\eAns
+ \Ans0 Other Asia, \mbox{specify: \fillin{1.25in}{\empty}}\eAns
+ \Ans0 Australia\eAns
+ \Ans0 New Zealand\eAns
+ \Ans0 Africa, \mbox{specify: \fillin{1.25in}{\empty}}\eAns
+ \eChoices
+\end{answers}
+\end{multicols}
+\end{problem}
+
+\def\myDing{\makebox[0pt][r]{\textcolor{red}{\ding{042}}\enspace}}
+
+\begin{eqComments}[]%
+\myDing If your company/organization uses \TeX/\LaTeX/\textsf{pdftex} in their business work flow,
+please answer questions \textbf{\textcolor{blue}{\ref*{buss1}}} and \textbf{\textcolor{blue}{\ref*{buss2}}}.
+\end{eqComments}
+
+\begin{problem}\label{buss1}
+How many employees work at your company including all
+sites? Select one:
+
+\setlength\columnseprule{0pt}
+\begin{multicols}{3}
+\begin{answers}{1}
+ \bChoices
+ \Ans0 One/work alone\eAns
+ \Ans0 2 - 9\eAns
+ \Ans0 10 - 49\eAns
+ \Ans0 50 - 99\eAns
+ \Ans0 100 - 499\eAns
+ \Ans0 500 - 999\eAns
+ \Ans0 1000 - 2999\eAns
+ \Ans0 3000 - 4999\eAns
+ \Ans0 5000 or more\eAns
+ \Ans0 Don't know\eAns
+ \eChoices
+\end{answers}
+\end{multicols}
+\end{problem}
+
+\begin{problem}\label{buss2}
+What is your company/organization's PRIMARY industry? Select one:
+
+\setlength\columnseprule{0pt}
+
+\begin{multicols}{2}
+\begin{answers}{1}
+ \bChoices
+ \Ans0 Aerospace\eAns
+ \Ans0 Automotive\eAns
+ \Ans0 Computer hardware\eAns
+ \Ans0 Computer software\eAns
+ \Ans0 Education\eAns
+ \Ans0 Engineering\eAns
+ \Ans0 Financial services\eAns
+ \Ans0 Government\eAns
+ \Ans0 Graphic design/fine art\eAns
+ \Ans0 Healthcare/social services\eAns
+ \Ans0 Insurance\eAns
+ \Ans0 Legal\eAns
+ \Ans0 Manufacturing\eAns
+ \Ans0 Membership organizations - religious, nonprofit, trade unions\eAns
+ \Ans0 Military\eAns
+ \Ans0 Pharmaceuticals/bio tech\eAns
+ \Ans0 Professional services (documentation)\eAns
+ \Ans0 Professional services (technical/IT/Internet)\eAns
+ \Ans0 Printing and publishing\eAns
+ \Ans0 Public and protective services (police, fire)\eAns
+ \Ans0 Retail\eAns
+ \Ans0 Telecommunications\eAns
+ \Ans0 Transportation\eAns
+ \Ans0 Travel\eAns
+ \Ans0 Wholesale\eAns
+ \Ans0 Other, \mbox{please specify: \fillin{1.25in}{\empty}}\eAns
+ \eChoices
+\end{answers}
+\end{multicols}
+\end{problem}
+
+\begin{eqComments}[Improvements in \TeX.]\end{eqComments}
+
+\begin{problem}
+What you most like to see improved in \TeX/\LaTeX? Use the space provided
+below:
+\begin{solution}[2in]
+\end{solution}
+\end{problem}
+
+
+\begin{eqComments}[Thank You] once again for participating in this survey.\end{eqComments}
+\begin{eqComments}[\GoToSubmit]
+Click on the left arrow to return to the first page to submit your responses.\end{eqComments}
+
+
+
+\end{exam}
+\end{document}