Emergency Connectivity Fund Family Survey
PLEASE COMPLETE THIS FORM BY FRIDAY, AUGUST 6, 2021.

Coshocton City Schools has an opportunity to participate in the FCC's Emergency Connectivity Fund, a $7.17 billion program that will help schools and libraries provide the tools and services their communities need for remote learning during the COVID-19 emergency period. ECF will help provide relief to millions of students, school staff, and library patrons and will help close the Homework Gap for students who currently lack necessary internet access or the devices they need to connect to classrooms. For eligible schools and libraries, the ECF Program will cover reasonable costs of laptop and tablet computers, WI-FI hotspots, etc.
Please help us by completing the survey below for EACH student in your home.
Email *
NAMES OF STUDENT(S) ENROLLED AT COSHOCTON CITY SCHOOLS
Please include the first name, last name, and grade level for each student in your household. Please skip the additional names and grade level sections if they do not apply.
Student 1 FIRST NAME: *
Student 1 LAST NAME: *
Student 1 GRADE LEVEL (2021-22 School Year): *
Required
Student 2 FIRST NAME:
Student 2 LAST NAME:
Student 2 GRADE LEVEL (2021-22 School Year):
Student 3 FIRST NAME:
Student 3 LAST NAME:
Student 3 GRADE LEVEL (2021-22 School Year):
Student 4 FIRST NAME:
Student 4 LAST NAME:
Student 4 GRADE LEVEL (2021-22 School Year):
1. Does each school-age child in the home have access to a device for learning online (this does not include a smartphone)? *
If you answered No to the previous question, how many devices would be needed? *Example: 1, 2, 3, 4, 5 (one for each student in the home who does not have access to a device for learning online).
If a device is available, what type of technology is it? (check all that apply)
What type of Internet access do you have at home? *
If you have Internet access, is it adequate to allow for remote learning for ALL students in the household concurrently? *
Name of individual completing the survey: *
Submit
Never submit passwords through Google Forms.
This form was created inside of Coshocton City Schools. Report Abuse