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)

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)

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)

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

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

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

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