Digital Equity Survey
PLEASE complete this survey for EVERY student enrolled at Axtell Community School. We are required to submit this information to the Nebraska Department of Education.
PURPOSE: To verify the need of students in order to ensure all students have equal access to technology as well as the necessary tools.
There are state funding opportunities in place that we could qualify for using this information. Thank you in advance for taking the time to help us in collecting this data!
Name of parent/guardian filling this out
Student Last Name (that claim this primary residence)
Student First Name (that claim this primary residence)
Student Grade Level
Primary residence address
What device does the student most often use to complete school work at home?
Is the primary learning device a personal device or school-provided? Is the primary learning device shared with anyone else in the household?
Personal - Dedicated (one person per machine)
Personal - Shared (sharing among others in household)
School Provided - Dedicated
School Provided - Shared
Can the student access the internet on their primary learning device at home?
No - Not Available
No - Not Affordable
No - Other
What is the primary type of internet service used at the residence?
Residential Broadband (e.g., DSL, Cable, Fiber)
Can the student stream a video on their primary learning device without interruption?
Yes - No issues
Yes - But not consistent
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This form was created inside of Axtell Community Schools.