21st CCLC Virtual Summer Program Survey
Please complete one survey for each child you would like to enroll in the virtual summer program. Deadline to submit survey is Wednesday, May 20, 2020.
Select School Site
Tallulah Elementary School
Wright Elementary School
Madison Middle School
Madison High School
Does your child need to participate in Credit Recovery?
Choose the course(s) your child need to participate in for Credit Recovery.
Would you like for your child to participate in a virtual summer program?
Will an adult be present to assist your child with logging in if necessary?
If a face to face summer program was offered, would you allow your child to participate?
Does your child have internet access?
No, but I will get an internet/wifi plan so that my child can have virtual access if my child is selected to participate in the program.
Does your child have access to a computer at home? (laptop, desktop, Chromebook)
What other devices does your child have access to?
Cell Phone (with internet access)
Tablet (iPad, Kindle, Android, etc.)
Game Console (with internet access)
Parent's Email address
Parent's Phone Number
Never submit passwords through Google Forms.
This form was created inside of Madison PSB.