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LDOE Connectivity Survey
This survey will gather information about your home internet connectivity
18
Questions
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1
What is your name?
*
This field is required.
First Name
Last Name
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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
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3
Which school(s) do they attend?
*
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Check all that apply
Laguna Early Head Start
Laguna Preschool Head Start
Laguna Elementary
Laguna Middle
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4
Names of children who are students at Laguna Early Head Start:
Please list the names of each child.
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5
Names of children who are students at Laguna Preschool Head Start:
Please list the names of each child.
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6
Names of children who are students at Laguna Elementary School:
Please list the names of each child.
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7
Names of children who are students at Laguna Middle School:
Please list the names of each child.
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8
Which village, or area, do you live in?
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9
Do you have internet service at home?
*
This field is required.
YES
NO
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10
Who is your Internet Service Provider?
Example: CenturyLink, K'awaika Hanu Internet, HughesNet, Verizon, T-Mobile
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11
What is the quality of your current Internet Service?
1
2
3
4
5
Bad
Excellent
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12
How many devices can you reliably have connected to your Internet Service at one time?
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13
How many family members are connected to your Internet Service during school hours?
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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
Other
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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.
YES
NO
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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
Other
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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
YES
NO
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18
Please enter your email address:
username@company.com
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