Digital Equity Survey

Student ID

Student First Name *

Student Last Name *

Student Attends

Student Attends - Please select one school *

Does this student have access to the internet at their primary place of residence? (SELECT ONE) *

Yes No

If No, what barrier prevents the student from having internet access at their primary place or residence?

Describe Other circumstances that prevent the student form having Internet access

What is the primary type of internet services used in the student’s primary place ofresidence? (SELECT ONE) *

Residential Broadband Cellular Network Hot Spot Community Provided Wd‐Fi Satellite Dial‐up Other None Unknown

Can the student complete a full range of learning activities without interruptions caused by poor internet performance in their primary place of residence? (SELECT ONE) *

Yes – Few or no internet interruptions Sometimes – Regularly experience internet No – Unable to access internet

Select the provider of the primary learning device: (SELECT ONE) *

District Provided Personal Other

Is the primary learning device shared or not shared with another individual? (SELECT ONE) *

Shared Not Shared Unknown

What type of device does the student use most often to complete learning activities away from school?(SELECT ONE) *

Desktop Computer Laptop Computer Tablet Chromebook Smartphone None Other

If you selected "Other" for your type of device, please explain