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Extended Learning Questionnaire
This form is to help determine which of our families with students will need assistance to continue their education from home entirely online.
PLEASE SUBMIT A RESPONSE BY 4:00 PM ON SATURDAY, MARCH 21. THE MORE CLEAR YOUR RESPONSES, THE BETTER WE CAN HELP FAMILIES IN OUR COMMUNITY.
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* Indicates required question
Please list the student(s) who resides in your home.
*
Your answer
What is your student(s) grade level? Check all that apply.
*
K
1
2
3
4
5
6
7
8
9
10
11
12
Required
Does your student have a device issued by USD 407 to use at home?
*
Yes
No
Does your student have access to a device to use at home that IS NOT issued by USD 407 that can be dedicated for education?
*
Yes
No
If you do have a device for them to use at home what is the brand, model, and year/operating system (i.e. Windows 8 or 10, Mac OSX, iPad, or Android)
Your answer
Does your student have internet access at home?
*
Yes
No
If you answered NO to having internet service at home, what is the street address of your student(s)' residence?
Your answer
What is the best phone number to contact you?
*
Your answer
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