*1.Provide the First and Last Name of UICS Scholar(s) that live in your household.(Required.)

*2.Check the grade(s) of the UICS scholar(s) listed is in question #1.(Required.)

K-2nd 

3rd

4th

5th

6th

7th

8th

*3.Provide the First and Last Name of the adult completing this survey.(Required.)

*4.Check the relationship you have the scholar(s) listed in question #1.(Required.)

Parent

Grandparent

Legal Guardian

Other 

*5.Provide the email address of the person listed in question #3.(Required.)

*6.Provide the best contact number for the person listed in question #3.(Required.)

*7.Does your family currently have access to everything you need at home for online learning activities? This includes reliable internet access and enough tech devices for children in the household to share. If your answer is YES, you can STOP after you answer this question and SUBMIT the survey.(Required.)

YES

NO

8.If you answered NO, for not having everything you need for online learning, please check the boxes below to indicate what you do NOT have access to currently. Check all that apply.

We do not have reliable internet access at home.

We do not have a laptop, Chromebook, or desktop computer at home.

We do not have a smartphone.

We do not have a tablet/iPad at home.

We do not have enough technology devices for our children to share.