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* 1. Student FIRST Name

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* 2. Student LAST Name

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* 3. Student Birthdate (MM/DD/YYYY)

Date

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* 4. Student ID Number (Lunch ID)

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* 7. Does your child have access to a chromebook or laptop for use during distance learning? 

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* 8. Does your child have access to a consistent, stable internet connection that can stream/show video on their device for distance learning?

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* 9. Will your student need support in using their device for distance learning? Please select any topics where your student may need support. Select all that apply.

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* 10. If you need support, please provide your contact information so we can help.

Please contact the Welcome Center at (860) 695-8400 with any questions or concerns about this survey.

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