School Closure Student Survey
Name: 


  1. Student Name


  1. Student ID #


  1. Date of Birth (Ex. 06/11/04)


  1. Mailing Address (Ex. 5301 Celebration Drive)


  1. City (Ex. Hope Mills)


  1. Zip Code (Ex. 28348)


  1. Mother's Name


  1. Mother's Cell Phone


  1. Mother's Email Address


  1. Father's Name


  1. Father's Cell Phone


  1. Father's Email Address


  1. What are your interests and hobbies?


  1. Do you have access to a computer outside of school?
    Yes
    No


  1. Do you have access to a computer, laptop, iPad, or other tablet? Please tell me which devices you have access to outside of school.


  1. Do you have access to the Internet outside of school?
    Yes
    No


  1. What class period is this?
    1
    2
    3
    4


  1. Do you have access to a webcam?
    Yes
    No


  1. What is the best time for you if we were to have a web conference? 





Christilyn Page
Gray's Creek High School
Hope Mills, NC