Distance Learning Survey
We are evaluating our students' access to technology. Complete the following household survey so we can best plan any future distance learning. Please list each student in the household individually. Thank you
Sign in to Google to save your progress. Learn more
Email *
Student 1 - First Name *
Student 1 - Last Name *
Student 1 - Grade *
Student 2 - First Name
Student 2 - Last Name
Student 2 - Grade
Clear selection
Student 3 - First Name
Student 3 - Last Name
Student 3 - Grade
Clear selection
Student 4 - First Name
Student 4 - Last Name
Student 4 - Grade
Clear selection
Do students in your household have access to the internet? *
If students have access to the internet at home, please list the internet provider.
Please select all available technology in the household a student may access for distance learning. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of John W. Rex Charter Elementary School. Report Abuse
Google Forms