Here is a non functional form, as it appeared on Monday, March 16th, 2010, after successfully logging in at this site:

I repeat, the form below does not work and is displayed only for informational purposes, it is shown here only to identify what Google has determined what may be pertinent to the application. If you want to fill out such a form, you need to have a gmail account (which you can easily obtain for free) and then log in at:

http://www.google.com/appserve/fiberrfi/public/options

and click the Nominate Your Community button.

Get involved: Residents and community groups

* Required fields

Your name: *

Your organization or community group:

If you are responding on behalf of an organization or community group, please describe it:

City: *

State: *

Why should Google build a fiber to the home network where you live? *

Web link to supporting material (YouTube videos and other creative submissions are encouraged!)

What kind of Internet services are available where you live? Check all that apply:

Dial-up
DSL
Cable Modem
Fiber to the Home
Wireless
Other
None
Don't know

What kind of Internet service do you primarily use at home?

What company provides your home Internet service?

What is the advertised speed of your home Internet service?

What is your actual download speed during the evening?

You can use a third-party website like Speedtest.net or tools at Measurement Lab and YouTube Speed to learn about your Internet connection.

What is your actual upload speed during the evening?

You can use a third-party website like Speedtest.net or tools at Measurement Lab and YouTube Speed to learn about your Internet connection.

How much does your Internet service cost per month?

Is your Internet service 'bundled' with other services like TV and phone?

How many times in the last month did your high-speed Internet service not work correctly, slow down, or frustrate you?

Describe the quality of your home Internet service customer support:

What would you like to see improved about your current service? Check all that apply.

Lower price
Faster speed
Higher reliability
Better customer support