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* 1. Do you have a designated place at home to do and focus on school work? (Somewhere quiet, somewhere safe, somewhere you can focus)

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* 2. What other responsibilities do you have during this time?

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* 3. What is challenging about this experience for you?

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* 4. What are you currently doing that you enjoy?

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* 5. How confident are you in your ability to do remote learning?

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* 6. Do you have access to a smartphone?

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* 7. Do you have access to a computer, laptop, or tablet?

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* 8. Do you have access to the internet at your home?

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* 9. How many internet devices do you have in your home?

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* 10. What ways would you prefer to access content while distance learning? (Check all that apply)

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* 11. What ways would you prefer to demonstrate your knowledge of content once you have learned it? (Check all that apply)

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* 12. My family/household is facing significant challenges at this time that are impacting my ability to do schoolwork:

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* 13. For your math class, which of the following do you prefer? (check all that apply)

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* 14. Which platform do you prefer for your classes? (check all that apply)

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* 15. We would like to know who you are so we can address any questions or issues you might have.  Please enter your name here or state that you prefer anonymity (just keep in mind we can't address your individual needs if you do)

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