Technology Survey - Parent Question Title * 1. What grade is your student in? Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade Question Title * 2. My student has access to a cell phone, iPad, Tablet, Xbox or other device they use regularly for gaming or Social Media. Yes, they have access to a device they use regularly Yes, they have access to a device, but rarely use it No, they do not have access to any technology device Question Title * 3. How often does your student use some type of technology? Daily 3-5 days a week 1-2 days a week My student does not use technology at all Question Title * 4. On average, when using technology, how much "screen time" does your student get? < 1 hour per day 1-2 hours per day more than 2 hours per day N/A; My student does not use technology Question Title * 5. Is your student allowed to use technology in their room at bedtime? Yes No Question Title * 6. What Social Media applications does your student use? (select all that apply) Facebook Instagram Musical.ly/Tik Tok Snapchat youtube Other; please list below I do not know what applications my student uses My student does not use any Social Media applications Other Social Media applications my student uses are: Question Title * 7. FortNite seems to be taking over the world. Is your student obsessed with FortNite? Yes, they would play FortNite for days if they could! Not really, they play FortNite occasionally NA, they do not play FortNite Question Title * 8. If your student has an Instagram account, do they also have a fake or "SPAM" account (aka Finsta) Yes No I do not know N/A I know my student does not have have an Instagram account Question Title * 9. What type of games does your student regularly play? FortNite Roblox Minecraft Call of Duty (any version) Other; please list below Other games my student plays regularly: Question Title * 10. I know my student's Logons and Passwords for their social media accounts? Yes No N/A My child does not participate on Social Media Question Title * 11. I feel my child's focus on "screen time" including texting, youtube/videos, gaming and social media is a distraction that negatively impacts their success at home or school. Yes No Somewhat Question Title * 12. I find it hard to enforce technology/gaming rules and limitations at home. Yes; I tend to give in to demand or not set rules at all Somewhat; I set rules but am not as good about enforcing them as I should be No; I set rules and make sure they are followed N/A My student does not use technology at all Question Title * 13. Has your student ever told you about seeing something inappropriate online? (Social Media site, you tube, DM, etc)? Yes No Question Title * 14. Has your student told you about kids being "bullied" or teased on Social Media/texting (DM)? Yes No Question Title * 15. Has your student every been directly involved in an online, or text message bullying situation? Yes No I do not know Question Title * 16. What has your student's experience with teasing/bullying been in grade school so far? Never Rarely Occasionally Regularly Question Title * 17. Would you or a family member be interested in taking part in parent group helping to address issues of bullying, teasing, violence and misconduct? Yes No Question Title * 18. If you would be interested in helping in this matter, what time of day words best for parent meetings? During the school day in the AM During the school day in the PM Immediately after school, around 3:30 Evenings, around 6:00 Question Title * 19. It would be appreciated if you would provide the information below. Your Name: Phone Number: Student Name: Question Title * 20. Do you have any other comments, questions, or concerns? Done