Internet & Health Survey
What school(s) does your child/children attend? *
Required
What is your child/children names and grades? *
Do you have internet? *
What speed of internet?
Does your child have access to a device at home that is capable of supporting online platforms like Google Classroom, Zoom, video player, etc. Include school devices in answer? *
Required
Has there been travel within the last 14 days in state or country identified as a hot spot? *
Has there been any exposure to an individual diagnosed with COVID-19? *
Is anyone in the home/family showing signs of illness including a fever greater than 100 degrees, cough, or shortness of breath? *
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This form was created inside of USD 223 Barnes-Hanover-Linn.