Student Technology Access and Travel/Contact Screening Survey

We are trying to be proactive with students and staff safety as we return to school from Spring Break. We would like to collect information about student health and travels over the break, as well as, gauge your family's level of access to technology resources if we are required to be out of school for a long period of time.

Please fill out the survey below. If you have a question or would like to discuss an individual health concern, please contact your child's campus principal at 647-1138 (Elementary) or 647-3216 (MS/HS) or Edie Scott (District Nurse).

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* 1. Student Name(s) and grade levels

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* 2. My family has access to the following technology resources if distance learning was required to complete classwork or homework (mark all that apply):

Internet access

Hot spot w/ data access

Home computer, laptop, or Chromebook

I-pad or other device

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* 3. What technology items would be necessary at home if distance learning was required to complete classwork or homework (mark all that apply):

Internet access or mobile hot spot

Laptop or Chromebook

None

Other (please specify)

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* 4. Has your child/children traveled to any of the CDC identified Level 3 countries in the last month? Level 3 Countries: China, Iran, South Korea, Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland Portugal, Slovakia, UK or Ireland.

Yes

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* 5. Has your child/children traveled to any of the following states in the last 2 weeks? Washington, California, Colorado, Georgia, Illinois, Massachusetts, Ohio or New York.

Yes

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* 6. Has your child/children traveled to any of the following Texas locations in the last 2 weeks? Dallas, Houston, Ft. Worth, Austin, El Paso, or San Antonio.

Yes

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* 7. Has anyone in the family been in contact with anyone known to have tested positive for COVID-19?

Yes

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* 8. Are any family members currently, or have they exhibited in the last 14 days, any of the following (mark all that apply):

cough

fever

shortness of breath

pain or pressure in the chest

bluish lips or face

None

Other (please specify)

Student Technology Access and Travel/Contact Screening Survey

Question Title

* 1. Student Name(s) and grade levels

Question Title

* 2. My family has access to the following technology resources if distance learning was required to complete classwork or homework (mark all that apply):

Question Title

* 3. What technology items would be necessary at home if distance learning was required to complete classwork or homework (mark all that apply):

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* 5. Has your child/children traveled to any of the following states in the last 2 weeks? Washington, California, Colorado, Georgia, Illinois, Massachusetts, Ohio or New York.

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* 6. Has your child/children traveled to any of the following Texas locations in the last 2 weeks? Dallas, Houston, Ft. Worth, Austin, El Paso, or San Antonio.

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* 7. Has anyone in the family been in contact with anyone known to have tested positive for COVID-19?

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* 8. Are any family members currently, or have they exhibited in the last 14 days, any of the following (mark all that apply):

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* 9. Please list any other foreign or domestic travel in the last two weeks.