LDOE Connectivity Survey

1

What is your name?* This field is required.

First Name

Last Name

2

How many of your children are students at an LDOE school?* This field is required.LDOE Schools: Early/PreSchool Head Start, Laguna Elementary School, Laguna Middle School

3

Which school(s) do they attend?* This field is required.Check all that apply

Laguna Early Head Start

Laguna Preschool Head Start

Laguna Elementary

Laguna Middle

4

Names of children who are students at Laguna Early Head Start:

Please list the names of each child.

5

Names of children who are students at Laguna Preschool Head Start:

Please list the names of each child.

6

Names of children who are students at Laguna Elementary School:

Please list the names of each child.

7

Names of children who are students at Laguna Middle School:

Please list the names of each child.

8

Which village, or area, do you live in?

9

Do you have internet service at home?* This field is required.

YESNO

10

Who is your Internet Service Provider? Example: CenturyLink, K'awaika Hanu Internet, HughesNet, Verizon, T-Mobile

12

How many devices can you reliably have connected to your Internet Service at one time?

13

How many family members are connected to your Internet Service during school hours?

14

What type(s) of device(s) does your family use to access the internet?Check all that apply

Smartphone (iPhone/Android)

iPad/Tablet

Desktop Computer

Chromebook/Laptop

TV/Game System

15

Do your students have access to their own distance learning capable device?Meaning an internet-ready device that has a camera, microphone and speaker.

YESNO

16

What type(s) of distance learning capable device(s) do your students have?Check all that apply

Smartphone (iPhone/Android)

iPad/Tablet

Desktop Computer

Chromebook/Laptop

17

Have you applied for the Emergency Broadband Benefit Program (EBB)?Up to a $75/month discount on your broadband service, or a one-time discount of up to $100 for a laptop, tablet, or desktop computer. https://getemergencybroadband.org/how-to-apply

YESNO

18

Please enter your email address:

username@company.com