Editing previous response:

Please fix the highlighted areas below before submitting.

Home Technology Access Survey

You only need to complete one form PER household.

Parent/Guardian First Name

Answer Required

Parent/Guardian Last Name

Answer Required

Does your household have access to a device such as a phone, tablet or computer that is able to play videos?*

Answer Required

Yes

Do you have internet capabilites to stream or download videos on your device?*

Answer Required

Yes

No, I am not able to download or stream videos onto my device

No, my household does not have access to a device as mentioned above

Confirmation Email

Confirmation Email *

Enter your email address here if you'd like to receive a confirmation upon submitting the form.

Email Required