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21st CCLC Virtual Summer Program Survey
Please complete one survey for each child you would like to enroll in the virtual summer program. Deadline to submit survey is Wednesday, May 20, 2020.
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Select School Site
Choose
Tallulah Elementary School
Wright Elementary School
Madison Middle School
Madison High School
Grade Level
Choose
Pre-K
Kindergarden
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
Does your child need to participate in Credit Recovery?
Yes
No
Clear selection
Choose the course(s) your child need to participate in for Credit Recovery.
English I
English II
English III
Algebra I
Algebra II
Geometry
World History
World Geography
Spanish I
Spanish II
Biology I
Biology II
Other
Clear selection
Student's Name
Your answer
Parent's Name
Your answer
Would you like for your child to participate in a virtual summer program?
Yes
No
Clear selection
Will an adult be present to assist your child with logging in if necessary?
Yes
No
Clear selection
If a face to face summer program was offered, would you allow your child to participate?
Yes
No
Clear selection
Does your child have internet access?
Yes
No
No, but I will get an internet/wifi plan so that my child can have virtual access if my child is selected to participate in the program.
Clear selection
Does your child have access to a computer at home? (laptop, desktop, Chromebook)
Yes
No
Clear selection
What other devices does your child have access to?
Cell Phone (with internet access)
Tablet (iPad, Kindle, Android, etc.)
Game Console (with internet access)
Parent's Email address
Your answer
Parent's Phone Number
Your answer
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