Emergency Connectivity Needs Survey

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* 1. Name of the Parents/guardian(s) that live in the home where the student(s) reside.

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* 2. How many children do you have and live with you in your home that attend Washington County Schools?

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* 3. Please provide your home address ( to help us determine availability of Internet resources)

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* 4. Name of the school your children attend (check all that apply)

Chatom Elementary School

Fruitdale High School

Leroy High School

McIntosh Elementary School

McIntosh High School

Millry High School

Washington County High School

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* 5. Name(s) of your children who are students in Washington Co. Schools.

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* 6. Select the grade(s) of your children (Check all that apply)

K

1

2

3

4

5

6

7

8

9

10

11

12

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* 7. Do you already have high-quality Internet in your home?

Yes

No

Other (please specify)

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* 8. Are you able to receive cellular service at your home?

Yes

No

Other (please specify)

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* 9. Do you currently participate in any government program that provides Internet to you in your home for your children's use?

Yes

No

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* 10. If you answered "yes" to the previous question, please tell us the name of the program in which you participate. Put NA if this does not apply to you.

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* 11. Would you accept Internet access in your home if it was offered at no cost to you?

Yes

No

Other (please specify)