Thanks to a tweet and link from @intrepidteacher I got the idea and source to create a survey about computer usage to start off the school year. He shared this PDF file to me via twitter. I do not know the original author to give credit to.
I find PDF to be terrible to work with plus I wanted to tweak it a bit so I used it to create a survey form in Google Docs.
The beauty of this is that it is paperless and I can invite students by e-mail to fill it out and the results will automatically be put into a spreadsheet for me to easily see the results. If you do not know how to do this check out this video which explains how to make a quiz in Google Docs simply.
I have shared a copy of this Doc with everyone giving you editor's rights. Feel free to use this survey or adapt as you see fit. Just go to this link. Got to File-Create a new copy. That step is important; otherwise you will be sharing results with everyone and they can edit your copy.
Next rename it as you please and change the rights so it is not shared with everyone.
If you goto Form you can see options to edit form, see live form, and embed form.
To use with students share it with them to view only by their e-mail addresses.