Student Technology Assessment Form
Please complete this form to help us understand your access to and comfort with technology for schoolwork and learning support.
Student Name
*
First Name
Last Name
Grade Level
*
Please Select
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
Which of the following devices do you have regular access to for schoolwork? (Select all that apply)
*
Laptop
Desktop Computer
Tablet
Smartphone
None
Other
Do you have reliable internet access at home?
*
Yes, always
Yes, sometimes
No
How comfortable are you using the following tools for schoolwork?
*
Rows
Very Comfortable
Somewhat Comfortable
Not Comfortable
Word Processing (e.g., Google Docs, MS Word)
1
2
3
Spreadsheets (e.g., Google Sheets, Excel)
4
5
6
Email
7
8
9
Learning Platforms (e.g., Google Classroom, Canvas)
10
11
12
Video Conferencing (e.g., Zoom, Teams)
13
14
15
How often do you use technology for the following activities?
*
Rows
Daily
Weekly
Rarely
Never
Completing assignments
16
17
18
19
Researching information
20
21
22
23
Collaborating with classmates
24
25
26
27
Communicating with teachers
28
29
30
31
Accessing learning resources
32
33
34
35
Rate your overall confidence in using technology for schoolwork.
*
1
2
3
4
5
Do you have a quiet place at home to use technology for schoolwork?
*
Yes
No
Sometimes
What kind of technology support would help you most with your schoolwork?
Help with using software or apps
Access to devices
Internet access support
Training or tutorials
None needed
Other
Is there anything else you would like to share about your technology needs?
Submit
Should be Empty: