Technology Survey Form

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Dear Harmony Families,
In response to recent school closures, we are gathering information about the ability of our students to continue learning at home using online materials and/or a virtual classroom. Please complete the following survey to help us understand the availability of the internet and devices in your home.
* Please fill out this form for each Harmony student you have.

Email *

Student's FIRST name/ Nombre de estudiante *

Student's LAST name/Apellido de las estudiantes *

Student's Grade Level/ grado *

Do you have internet access at Home?/ ¿Tienes acceso a internet en casa? *

YES

Do you have a technology device available for at-home learning your student can use? / ¿Tiene un dispositivo tecnológico disponible para el aprendizaje en el hogar que su estudiante pueda usar? *

YES

Parent/Guardian FIRST name/ Nombre del padre / tutor *

Parent/Guardian LAST name/ Apellido del padre / tutor *

Please provide a good email address that your campus could contact you for the next step./ Proporcione una buena dirección de correo electrónico con la que su campus pueda contactarlo para el siguiente paso. *

Please provide a good phone number in case we need to contact you./ Proporcione un buen número de teléfono en caso de que necesitemos contactarlo. *

Send me a copy of my responses.

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