JNPSD Digital Equity Survey

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Parent/Guardian Name (First and Last Name) *

Scholar's Name (First and Last Name) *

Scholar's Grade *

Does this child have internet access at home? *

Yes

If there is no Internet Access, what is the reason this child does NOT have internet access?

Not Available

Not Affordable

Not Applicable

Other:

Clear selection

Please indicate the type of internet service the student would use to complete online assignments. *

Residential Broadband

Cellular Network

Hotspot

Community Provided Wi-Fi

Satellite

Dial-up

None

Unknown

Other:

Indicate the reliability of the internet service the student has available to them at home. *

Few or no interruptions

Sometimes - Regularly experience internet interruptions

Poor internet performance

N/A - Not Applicable

Please indicate the type of device the student would use to access lessons online. *

Desktop Computer

Laptop Computer

Tablet

Chromebook

Smartphone

None

Other:

What is the source of this primary learning device? *

District Provided

Personal

N/A

Other:

Would the learning device (computer, laptop, tablet, etc.) be shared with other individuals? *

Shared

Not Shared

Unknown

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