Student/Family Technology Access and Use Survey
Please answer the following questions regarding your experience with computer technology. It is important that you answer truthfully.
Please give the parent's email address, not the student's.
Please fill this out for EACH student.
If you have questions, or need help completing the form, please contact Christy Aymami, Director of Educational Technology at
Parent First and Last Name
Student First Name
Student Last Name
What grade are you /your "homeschool" student(s) currently in?
Where have you/your "homeschool" student(s) used a computer this school year? (check all that apply)
Classroom - In School
Computer Lab - In School
School Library - In School
Public Library or Community Center
Do you have computer access to complete school assignments?
How often do you use a computer outside of school?
Less than weekly
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This form was created inside of Discovery Health Sciences Foundation.