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* 1. Your name:

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* 2. Full name of child(ren):

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* 3. Name of child(ren)’s class(es):

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* 4. How many of the following technology devices are in your home?

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* 5. How many people in your household share these devices?

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* 6. What type of internet access do you have in your home?

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* 7. How many school-aged children live in your household?

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