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Internet Connectivity Survey
NOTE: If you are currently missing or did not turn in a Verizon Hot Spot at the end of the last school year, another one will not be issued to you.
Guardian Name
Please provide first and last name.
Your answer
Number of students in household attending Pleasant Hill Elementary School
Example: 0, 1, 2, etc.
Your answer
Number of students in household attending Pleasant Hill Middle School/High School
Example: 0, 1, 2, etc.
Your answer
Do you have adequate Internet connectivity for education and learning purposes?
Yes
Sometimes
No
Clear selection
If answer is No or Sometimes, please list physical address.
Your answer
How do you access the Internet at home?
Broadband (via cable vendor)
DSL (through phone company)
Dial-Up (must connect via phone dial)
Cellular Service
No Internet access
Clear selection
Is your student able to stream videos and connect to other educational content on a device?
Yes
Sometimes
No
Clear selection
Who is your ISP (Internet Service Provider) if you have one?
Your answer
If you stated no to to any of the above questions, do you need a Verizon Hot Spot for education and learning purposes?
Yes
No
Clear selection
Submit
Clear form
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