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Digital Equity Survey
PURPOSE: To verify the need of students in order to ensure all students have equal access to technology as well as the necessary tools. Please fill out 1 SURVEY per student.
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* Indicates required question
Student Name (first and last) that claim this primary residence.
*
Your answer
Grade Level
*
Choose
Kindergarten
1
2
3
4
5
6
7
8
9
10
11
12
Other
Primary residence address
*
Your answer
What device does the student most often use to complete school work at home?
*
1: Desktop Computer
7: Laptop Computer
2: Tablet
3: Chromebook
4: SmartPhone
5: Other
6: None
Is the primary learning device shared with anyone else in the household?
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1: Shared
2: Not shared
3: Unknown
Is the primary learning device a personal device or school-provided?
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1: Personal
2: School
3: Other
Can the student access the internet on their primary learning device at home?
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1: Yes
2: No
If no, what is the barrier to internet access in the home.
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1: Not available
2: Not affordable
3: Other
If yes, what is the primary type of internet service used at the residence?
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1: Residential Broadband (e.g., DSL, Cable, Fiber)
2: Cellular Network
3: HotSpot
8: Community Provided Wi-Fi
4: Satellite
5: Dial-up
6: Other
7: None
9: Unknown
Can the student stream a video on their primary learning device without interruption?
*
1: Yes
2: Sometimes
3: No
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This form was created inside of Educational Service Unit #16.
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