Climax Shelly School Technology Survey
The Climax-Shelly School is requesting your participation in a survey to determine the capacity of our students to access technology from their homes. Your participation will allow us to better serve your child's needs by having a better understanding of their ability to access broadband wireless internet and the number and types of devices in their households. This information is also essential as we initiate our distance learning plan next week. Please complete only one survey per household.
Email address *
Parent Name *
Phone (999-999-9999) *
Home Address (full address) *
Student Names and Grade (Joe Smith 9, Bob Smith 6) *
Does your Student have access to high speed WIRELESS internet at home? *
Do you have a device Per STUDENT? *
If yes what kind of device?
Does your student need meals *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Climax-Shelly School.