River Delta Joint Unified School District Survey

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Dear Parent/Guardian
If you struggled or are currently struggling to afford your internet bill during COVID-19 pandemic, the Emergency Connectivity Fund (ECF) may be able to help you. This federal program will provide River Delta Joint Unified School District with funds to purchase equipment such as laptops and tables for qualifying students to connect to the Internet, as well as cover the monthly cost of Internet access in qualifying homes. Please complete the following questions to aid the district in applying for and receiving ECF funds.

Date *

YYYY

Your full name *

Street Address *

City *

State *

Zip *

Please check any or all of the boxes below that apply to your situation as of March 1, 2020, showing you may be a qualifying household. *

As of March 1, 2020 I had NO Internet access at my residence.

As of March 1, 2020 I had insufficient Internet access at my residence.

As of March 1, 2020 I had NO equipment to connect to the Internet at my residence. This equipment could be a laptop, Chromebook or a tablet.

As of March 1, 2020 I had sufficient Internet access at my residence

Required

Please check any or all of the boxes below that apply to your situation as of July 1, 2020 showing you may be a qualifying household. *

As of July 1, 2021 I will NOT have Internet access at my residence without continued assistance.

As of July 1, 2021 I will NOT have sufficient Internet access at my residence without continued assistance.

As of July 1, 2021I will NOT have the necessary equipment to connect to the Internet at my residence without continue assistance. This equipment could be a laptop, Chromebook or a tablet.

As of July 1, 2021 I will have sufficient Internet access at my residence without assistance.

Required

Student Name - List all students of residence *

School Name - List all schools students will be attending for school year 2021-22. *

I hereby certify that, to the best of my knowledge, the provided information is true and correct *

Yes

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