Santee Digital Equity Question Title * 1. Household Dwelling Information Name of Head of Household : Street Address : Apartment Number : City : Question Title * 2. Single Family Dwelling Or Multi Family Dwelling (2 or more units) Single Multi-Family Question Title * 3. Is Dwelling listed above: Owned Housing Renting Question Title * 4. How many persons live at this address? Question Title * 5. How many families live at this address? Question Title * 6. How many persons are school age or in school (PreK-12) Or taking college classes? Question Title * 7. Of the school attendees in the household how many computers do you have in your dwelling? Question Title * 8. How many persons require health monitoring or telehealth (video) consultations? Question Title * 9. How many persons work from home? Question Title * 10. Does this household dwelling have internet access? Wired (Cable or DSL, Great Plains) Fixed Wireless (Santee Communications) Mobile Cellular (Version, AT&T, USCelluar, T-Mobile) Other Question Title * 11. Does the Internet access have adequate speed? Yes No Question Title * 12. Is the internet access affordable? Yes No Question Title * 13. Is the internet access reliable? Yes No Question Title * 14. How many laptop or desktop computers at this address? Question Title * 15. How many Tablet computers at this address? Question Title * 16. How many smartphones, cellphones (internet connected cell phones) at this address? Question Title * 17. How many smart televisions do you have in the home? Question Title * 18. Do you stream movies or use streaming apps? Yes No Question Title * 19. What is the age of the most technical person in the household? Question Title * 20. Do you or someone in the household use on-line Gaming devices like Xbox? Yes No Question Title * 21. Rate Each of the following skillsets or potential training courses as Most important to least important (5 Most important 1 least)How to operate a cell phone or computer 1 2 3 4 5 Question Title * 22. How to apply for jobs or work from home 1 2 3 4 5 Question Title * 23. How to apply for government services or submit government information 1 2 3 4 5 Question Title * 24. How to do telehealth or research health services 1 2 3 4 5 Question Title * 25. How to order products and/or services online (eCommerce) 1 2 3 4 5 Question Title * 26. How to take online classes or training 1 2 3 4 5 Question Title * 27. How to participate in social media (Facebook, Twitter, Intagram, etc....) 1 2 3 4 5 Question Title * 28. How to select streaming services (E.g., Hulu, Netflix, Apple+, etc....) 1 2 3 4 5 Question Title * 29. Does your household qualify for affordable Connectivity Program benefits? Please check all below that apply to this household. Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamp Medicaid Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Supplemental Security Income (SSI) Public Housing, and Affordable Housing Programs for American Indians Veterans Pension and Survivors benefits Free and Reduced-Price School Lunch Program or School Breakfast Program Received a Federal Pell Grant in the current award year Bureau of Indian Affairs General Assistance Head Start (only households meeting the income qualifying standard) Tribal temporary Assistance for Needy Families (Tribal TANF) Food Distribution Program on Indian Reservations Submit