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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)

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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)

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

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

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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?  

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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?

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