• Section 2: Internet Service
    		•

    Section 1: Student Information




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    Section 1: Student Information

    • Total number of students attending in the home? (dropdown)

      • 0-10

    [If 0, terminate]

    • Home Address (separate fields for street address, apartment number, zip code, etc.):

    • (Repeat information below for each child)

    • Student Name: First, Middle, Last

    • Student ID (restrict to current # of digits; numbers only):

    • Grade level (dropdown): PK-12

    • Attending School Name (dropdown):




    Section 2: Internet Service

    1. Which best describes your internet connectivity? (button)

      1. I access the internet at home through a fixed connection (e.g., DSL, fiber, cable, etc.), satellite, fixed wireless, or hotspot.

      2. I access the internet primarily through my phone.

      3. I access the internet in public spaces (e.g., library, businesses).

      4. I do not have internet connectivity.

    [If answered “a: I access the internet at home,” to Question 1, skip to question 5]

    1. What of the following best describes the reason you do not subscribe to internet service? Select the most important reason. (button)

      1. Service is not available (availability)

      2. Service is too expensive (affordability)

      3. Do not see a need for internet service (e.g., not relevant for my family’s needs, reliable internet outside of home, smartphone used to access the internet)

      4. Do not want internet service (e.g., data privacy concerns, don’t want kids to have too much screen time, don’t want kids exposed to bullying and/or online content, installation is inconvenient)

      5. Do not know how to subscribe to internet service (e.g., it is confusing, information is unavailable in appropriate language)

      6. Cannot subscribe to internet service (e.g., don’t have a social security number, don’t have bank account or access to credit, outstanding bills with the internet provider, move around too much)

      7. Other (please describe)

    [If answers “e. Do not know how to subscribe to internet service,” continue to question 3]


    1. What is the most confusing or difficult part of subscribing to internet service?

      1. Knowing how internet service works

      2. Selecting the best internet service plan for my family

      3. Knowing which carriers or internet service providers are preferable

      4. Installation

      5. Using the internet service in the home

      6. Troubleshooting service interruptions


    2. Have you subscribed to at-home internet service in the past? (button)

      1. Yes

      2. No


    3. Does the school district pay or subsidize your at-home internet connectivity? (e.g., school-provided hotspot or subsidized fixed internet connection).

      1. Yes, the school districts helps me connect to the internet at home.

      2. No, the school district does not help my student connect to the internet at home.


    4. Where do you spend most of your time connecting to the internet? (button)

      1. Home

      2. Friend or family member’s home

      3. School

      4. Work

      5. Public library

      6. Public transit

      7. Church

      8. Community center

      9. Other (please list)

    [If answered b, c, or d to Question 1, skip to Question 13]

    1. What type of internet service is provided in your home? (button)

      1. Wired connection (Cable, Fiber, DSL, etc.)

      2. Satellite

      3. Wireless connection through a mobile device and mobile provider (Hotspot, LTE)

      4. An internet connection at location that is not in your home (e.g. wireless provided within apartment building)

      5. Other (please list)

      6. Not sure


    2. OPTIONAL: What is the internet download speed in your home? If unsure, please see https://www.speedtest.net/ to test the speed at your household. (button)

      1. 0 – 10 Mbps

      2. 11-25 Mbps

      3. 25-50 Mbps

      4. 50-100 Mbps

      5. 100+ Mbps

      6. Not sure


    3. Which of the following activities do you perform in your home with ease? (Yes/No)

      1. Surf the web (e.g., check email, read the news)

      2. Browse social media

      3. Download pictures and videos

      4. Watch Netflix and use other streaming services


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