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MHS Student Tech Needs Survey
A form to collect information about student Technology and Access Needs.
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Last Name of Student
Your answer
First Name of Student
Your answer
Student ID Number
Leave Blank if unknown
Your answer
Is Student Special Ed?
Do not answer if unknown or not sure.
Yes
No
Clear selection
Name of Parent/Guardian
Leave Blank if unknown
Your answer
Parent/Guardian Phone Number
Leave Blank if unknown
Your answer
Parent/Guardian email address
Leave Blank if unknown
Your answer
Student needs a Laptop?
Yes
No
Clear selection
Student needs Internet Access?
Yes
No
Clear selection
Student needs Language Support?
Yes
No
Clear selection
Submit
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