2021-22 Digital Equity Form
PLEASE SUBMIT A SEPARATE FORM FOR EACH STUDENT

The Nebraska Department of Education (NDE) is requiring that digital equity (home/primary residence internet access) information be reported for all students.

Please use the name of the student as it is indicated on their official enrollment (not nickname).
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Student First Name *
Student's first name as listed in enrollment.
Student Last Name *
Student's last name as listed in enrollment.
Student's Date of Birth *
MM
/
DD
/
YYYY
Student Grade *
Primary Learning Device Away From School - What device does the student most often use to complete learning activities away from school? *
Primary Learning Device Access - Is the primary learning device shared with anyone else? *
Primary Learning Device Provider - Who provided the primary learning device to the student? *
Internet Access in Residence - Can the student access the internet in their primary place of residence? *
Barrier to Internet Access in Residence - If the student is unable to access the internet in their primary place of residence, why not? *
Internet Access Type In Residence - What is the primary type of internet service used in the students primary place of residence? *
Internet Performance in Residence - Can the student complete learning activities such as streaming video and uploading assignments without interruptions caused by poor internet performance? *
Parent/Guardian First & Last Name *
Email Address *
Parent Phone Contact # *
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