P-TECH

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* 1. Please provide us with your contact information (Students)

Name

Address

City/Town

State/Province

ZIP/Postal Code

Phone Number

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* 2. Please provide Parents cell phone number, parent E-mail

Cell:

E-mail:

Home Phone:

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* 3. Do you have access to a computer at home or electronic device?

Yes

No

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* 4. Do you have access to internet?

Yes

No

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* 5. Current grade?

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* 6. Students taking college courses only, do you know how to access Blackboard?

Yes

No

N/A

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* 7. Have you been able to log into Google Classroom

Yes

No

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* 8. Students with mandated services, do you have access to video conferences?

Yes

No

N/A