Home Internet & Device Survey for Families
Please enter parent/guardian first name.
Please enter parent/guardian last name.
Please enter parent/guardian email address.
Please enter your child/children's name(s)
What grade(s) are your child/children in? Please check all that apply.
Middle School Extension
If you have older children, will they be able to do schoolwork during school hours, or will they be caring for younger children in your household?
I have an older child and they will be fully available during school hours
I have an older child and they will need to babysit younger children
I'm not sure
This does not apply to my household
What device(s) is/are available for your child(s) to use for online work during the school day? (Please list all that apply)
Mac or Windows (PC) Laptop
Mac or Windows (PC) Desktop
Smartphone (e.g. iPhone, Android)
There is not a device available
If you have multiple children, do you have enough devices for each child to work simultaneously during school hours, or do the children need to share one device?
We have enough devices for all of our students to work at the same time
We have one or two devices but not enough for everyone to use at the same time
We do not have any devices
Please provide the name of your Home Internet Provider (not your cellular provider)
Comcast / Xfinity
Please run a speed test from the device(s) you plan to have your child use for online learning by going to:
and entering the number you see on the screen
Is there anything else you would like us to know about your internet or device access as it relates to your child being able to participate in online learning from home during the school day?
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This form was created inside of Northwest Chinese Academy.