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Digital Equity Survey
Gather information for GEERS Money/Cares ACT to provide internet access to Nebraska Families. Each household must fill our this survey in order to qualify.
* Indicates required question
Email
*
Your email
Legal First Name
*
Your answer
Legal Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Please list your students names.
*
Your answer
1.
Do you have internet access?
*
Yes we have internet
No because it is not AVAILABLE
No because it is not AFFORDABLE
Other:
How is your Internet Performance?
*
No Issues
Not Consistant
We have no Internet
Other:
What is your Primary Access Type?
*
Residential Broadband
Cellular Network
School Provided Hot Spot
Dial Up
None
Other:
What is your Primary Device Access?
*
Personal Dedicated-one per person
Personal Shared
School Provided Dedicated-one per person
School Provided Shared
None
Other:
What is your Primary Device
*
Desktop/Laptop
Tablet
Chromebook
Smart Phone
None
Other:
Send me a copy of my responses.
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