Student Technology Intake Survey - California Adult Education Program

1. Where do you go to school? *
Select the drop-down list and type the first letter of your school name to jump to that section of the list.

Jurupa Adult School (Jurupa Unified School District)

2. What is your first and last name?

First

Last

3. Choose the classes or programs that interest you. (Check all that apply) *

Basic Skills

High School Diploma
HS Diploma

High School Equivalency (GED, HiSET)
HS Equivalency - GED, HiSET

English as a Second Language
English as Second Language

Citizenship Preparation

Career Technical Education

4. Do you use email? *

Yes
No

5. How do you communicate or talk with others? (Check all that apply)

Text (SMS/iMessage)

Email

Other

6. Have you ever taken an online (remote) class? *

Yes
No

7. Do you prefer to learn online (remote), in-person, or both (hybrid)? Please explain why. *

Online (remote)
In-person
Both (hybrid)

Why do you like to learn this way?

8. What devices do you use? (Check all that apply) *

Cell phone

Do you own a cell phone?
Do you share a cell phone?
Do you use a cell phone for online learning?

Tablet

Do you own a tablet?
Do you share a tablet?
Do you use a tablet for online learning?

Laptop or Computer or Chromebook

Do you own a laptop or computer or Chromebook ?
Do you share a laptop or computer or Chromebook?
Do you use a laptop or computer or Chromebook for online learning?

9. How do you connect to the internet? (Check all that apply) *

Through my phone

Wifi/Internet connection in my home

Personal Hotspot

WiFi in the community

WiFi at school

Other

10. Do you have reliable and affordable internet at home? *

Yes
No, it is too expensive right now
No, it usually doesn’t work
No, it is too slow to use

11. Please mark the items below that would help you to study online. (Check all that apply) *

A device to help me study online

Help to get on the Internet like a mobile hotspot

Tech support getting into online classes, using online resources, fixing equipment, etc.

Flexible study times

A basic computer or keyboarding class

I do not need additional help

Other

12. Do you know how to keep your information safe when using a computer or going online? *

Yes
No