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.
Number of students in household attending Pleasant Hill Elementary School
Example: 0, 1, 2, etc.
Number of students in household attending Pleasant Hill Middle School/High School
Example: 0, 1, 2, etc.
Do you have adequate Internet connectivity for education and learning purposes?
Clear selection
If answer is No or Sometimes, please list physical address.
How do you access the Internet at home?
Clear selection
Is your student able to stream videos and connect to other educational content on a device?
Clear selection
Who is your ISP (Internet Service Provider) if you have one?
If you stated no to to any of the above questions, do you need a Verizon Hot Spot for education and learning purposes?
Clear selection
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This form was created inside of Pleasant Hill School District.