Student Technology Needs Assessment Scholar Name* First Last Scholar Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code School Name*UPSM Elementary SchoolUPSM Middle SchoolUPSM High SchoolUPA Elementary School - Mark Murray CampusUPA Elementary School - Ellen Thompson CampusUPA Middle SchoolUPA High SchoolUPAD: Elementary SchoolUPAD: Middle SchoolUPAD: High SchoolSchool Grade*K123456789101112Do you currently have internet access at home?*YesNoPlease check one of the following options for your scholar’s technology needs for the 2020-2021 school year.*Yes, my scholar will require the use of a U Prep Schools Chromebook for the 2020-2021 school year. (Please complete Parent Liability form)No, I decline the use of a U Prep Schools Chromebook for the 2020-2021 school year. My scholar would like to use their own technology device, at home as well as school. I understand that my scholar will still be responsible for completing all assignments while at school and including any assignments assigned through our distance learning program. i.e. Google Classroom. I understand U Prep Schools is not responsible for this device, while on campus.Parent / Guardian Name* First Last Parent / Guardian Email Address* Enter Email Confirm Email Parent / Guardian Consent* I agree to this technology needs assessmentBy checking this box, you agree to the terms outlined above.