SURVEY OF UNMET NEED FOR INTERNET ACCESS OR CONNECTED DEVICES AT HOME
The FCC’s Emergency Connectivity Fund provides funding for schools to cover expenses for Internet services and connected devices for students who lack sufficient access for remote learning including homework. To help determine our needs for the 2021-22 school year, please complete and return the following survey within 36-Hours.
Please provide Home Address
Number of students residing in your household who will attend school fall 2021
3. If the school does not provide internet access, do you have internet access in your home sufficient to allow each school-age child to engage in remote learning (e.g. complete internet-based homework assignments or participate in online video classes)?
4. If the school does not provide connected devices (e.g. laptop or tablet), does every school-age child in your home have access to a connected device sufficient to engage in remote learning (e.g. complete internet-based homework assignments or participate in online video classes)?
4a. If no, please list the students who need access to a device below. Please provide NAME OF STUDENT, GRADE OF STUDENT IN FALL 2021, AND CANADIAN ELEMENTARY OR CANADIAN HIGH SCHOOL.
5. If I answered “no” to any of the questions above, I certify that the student(s) residing in our household would not be able to sufficiently engage in remote learning if the connected devices and/or Internet access were not provided by the school. Provide Full Legal Name in the Box below as certification.
Date Survey Completed
Send me a copy of my responses.
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This form was created inside of Canadian Public School.