SURVEY TEMPLATES

Supporting Students & Families in Out-of-School Learning

Sample
Out‐of‐School
Connec2vity
Survey

These
surveys
were
created
in
partnership
with
the
Friday
Institute
for
Educational
 

Innovation
at North
Carolina
State
University.

The
student
and
parent
survey
items
on
the
following
pages
can
be
used
by
the
district
or
at
the
school
level 

to
give
context
to
the
so‐called
‘homework
gap’
in
your
community.
A
good
survey
will
begin
to
uncover
and

profile
in
some
detail
the
nature
of
the
challenges
to
out‐of‐school
Internet
access
that
your
students,

and
parents/guardians,
may
experience.
Minimally,
a
survey
should
address
devices,
places
and
speed.





These
are
templates
intended
as
a
starDng
point;
customize
or
alter
them
to
suit
your
situaDon.


For
example,
if
a
district
has
already
decided
to
send
Chromebooks
home
with
students,
the
parent

survey
might
ask,
“If
your
child
is
assigned
a
Chromebook
by
his/her
school,
what
opDons
exist
to
connect

that
device
to
the
Internet
using
Wi‐Fi
in
your
home?”

February 2016
 Student
Survey:
What
type
of
technology
do
you
use
at
home?
 What
school
related
ac2vi2es
do
you
do
on

(Check
all
that
apply) your
device?
o


Desktop
PC o


Reading
o


Laptop o


WriDng
o


iPad o


Math
o


Android
tablet o


Projects/PresentaDons
o


Kindle
or
Nook o


Research
o


Chromebook o


Other
(Please
specify)
o


Smart
phone
o


None Overall,
how
comfortable
are
you
using
your

o


Other
(please
specify) device
for
schoolwork?
o


Not
at
all
comfortable
How
do
you
access
the
Internet
at
home? o


Not
very
comfortable
o


Broadband
(through
a
cable
company
 o


Somewhat
comfortable
hotspot) o


Very
Comfortable
o


DSL
(through
the
phone
company)
o


Dial‐Up
(must
connect
via
phone
dial) What
other
ac2vi2es
do
you
use
your
device

o


Cellular
service
 for?
o


No
Internet
access o


Social
Media
(e.g.,
Twi\er,
Instagram,

Snapchat,
etc.)
Are
you
able
to
access
and
or
use
your
device
 o


Games
to
do
schoolwork? o


Music
o


I
can’t
use
my
device
at
home o


Movies
o


Limited
access
1‐2
hours o


Digital
Art
o


Medium
access
3‐4
hours o


Media
(e.g.,
online
magazines,
TV

o


Unlimited
access shows,
etc.)
o


Other
(Please
specify)

(student
survey
conDnued
next
page)

created in partnership with the

Friday Institute for Educational Innovation
at North Carolina State University

Digital Equity Action Toolkit Page 1

 (student
survey
conDnued)

Do
you
use
the
Internet
to
complete
your
 What
is
the
connec2on
speed
that
you
need,

schoolwork
outside
of
school? to
engage
in
anywhere,
any2me
learning?
o


Never o


Moderate.
Enough
to
get
online,

o


SomeDmes check
in,
and
comfortably
browse
the

o


O^en web.

o


Always o


Fast.
Enough
to
smoothly
stream

video,
quickly
download
large
files,
etc.

How
many
other
members
of
the
household
 o


Lightning
speeds.
Fastest
possible

share
the
device
you
primarily
use
for
 connecDon
for
all
sorts
of
projects.
schoolwork?
o


1 Do
you
have
access
to
this
connec2on
speed
in

o


2 your
home?
o


3 o


Yes
o


4 o


No
o


5+ o


Most
of
the
Dme,
but
not
always
o


SomeDmes,
but
not
enough

Do
you
use
your
personal
device
while
at
 o


Other
situaDon
(explain)


school?
o


Yes
o


No Do
you
have
access
to
this
connec2on
speed
in

other
places
in
the
community
where
you
do

What
other
places
in
your
community
do
you
 school
work?
use
to
access
the
Internet? o


Yes
o


Library o


No
o


Commercial
Business
(e.g.,
coffee
 o


Most
of
the
Dme,
but
not
always
shop,
restaurants,
etc.) o


SomeDmes,
but
not
enough

o


A
Friend’s
House o


Other
situaDon
(explain)


o


A
Family
Member’s
House
o


Place
of
Worship
o


Other
(Please
Specify)

created in partnership with the


Friday Institute for Educational Innovation
at North Carolina State University

Digital Equity Action Toolkit Page 2

 Parent
Survey:
What
type
of
technology
do
you
use
at
home? Overall,
how
comfortable
are
you
using
your
home

o


Desktop
PC device?
o


Laptop o


Not
at
all
comfortable
o


iPad o


Not
very
comfortable
o


Android
tablet o


Somewhat
comfortable
o


Kindle o


Very
Comfortable
o


Chromebook
o


Other
(please
specify) How
many
other
members
of
the
household
share

the
device(s)?
How
many
devices
are
being
used
in
the
 o


1
household? o


2
o


1 o


3
o


2 o


4
o


3 o


5+
o


4 If
you
have
a
smartphone
or
mobile
broadband

o


5+ modem,
who
is
your
Service
Provider
for
the
Data

How
do
you
access
the
Internet

at
home? Plan?
o


Broadband
(via
cable
vendor
hotspot) o


AT&T
o


DSL
(through
phone
company) o


Verizon
o


Dial‐Up
(must
connect
via
phone
dial) o


Sprint
o


Cellular
service
 o


T‐Mobile
o


No
Internet
access o


Kajeet
o


US
Cellular
How
oGen
do
you
use
your
home
device
for
 o


Other
(please
specify)
personal
use
(e.g.,
business,
bill
pay,
etc.)?
o


Generally
don’t
use
computer
at
home Would
you
be
willing
to
allow
your
child
to
use

o


Limited
access
1‐2
hours personal
device
in
school
if
it
were
part
of
the

o


Medium
access
3‐4
hours curriculum?
o


Unlimited
access o


Yes
(please
explain)
o


No
(please
explain)

(parent
survey
conDnued
next
page)

created in partnership with the 


Friday Institute for Educational Innovation
at North Carolina State University

Digital Equity Action Toolkit Page 1

 (parent
survey
conDnued)

What
is
the
connec2on
speed
that
you
need
for

your
child
to
stay
connected
to
learning
and

school,
and
for
you
to
stay
connected
to
their

school?
o


Moderate.
Enough
to
get
online,
check
in,

and
comfortably
browse
the
web.

o


Fast.
Enough
to
smoothly
stream
video,

quickly
download
large
files,
etc.

o


Lightning
speeds.
Fastest
possible

connecDon
for
all
sorts
of
projects
and

acDviDes.

Do
you
have
access
to
this
connec2on
speed
in

your
home?
o


Yes
o


No
o


Most
of
the
Dme,
but
not
always
o


SomeDmes,
but
not
enough

o


Other
situaDon
(explain)



Do
you
or
your
child
have
access
to
this
connec2on

speed
in
other
places
in
the
community
where
you

go
or
where
your
child
does
school
work?
o


Yes
o


No
o


Most
of
the
Dme,
but
not
always
o


SomeDmes,
but
not
enough

o


Other
situaDon
(explain)



created in partnership with the


Friday Institute for Educational Innovation
at North Carolina State University

Digital Equity Action Toolkit Page 2

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