JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Parent & Student Information:
This form will be used by the State of Nebraska to determine eligibility for Rural Internet Access funds.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student Last Name:
*
Your answer
Student First Name:
*
Your answer
Parent Email Address:
*
You must put in an email address.
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of NebraskaPowerschoolCooperative.
Report Abuse
Forms
