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).
Sign in to Google
to save your progress.
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
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?
Community Provided Wi-Fi
Internet Performance in Residence - Can the student complete learning activities such as streaming video and uploading assignments without interruptions caused by poor internet performance?
Yes - The student experiences very few or no interruptions in learning activities caused by poor internet performance in their primary place of residence.
Sometimes - The student regularly experiences interruptions in learning activities caused by poor internet performance in their primary place of residence.
No - The student is unable to complete learning activities due to poor internet performance in their primary place of residence.
Parent/Guardian First & Last Name
Parent Phone Contact #
Never submit passwords through Google Forms.
This form was created inside of Holdrege Public Schools.