Survey | Miami Valley Career Technology Center

= Required

First Name (Use legal name)

Last Name (Use legal name)

SSID

Example: AB1234567

Birth Date

mm/dd/yyyy

Personal Email Address

Program Teacher

Graduation Year

Address

City

State

Zip

Home Phone

(###) ###-####

Cell Phone

(###) ###-####

Please enter any social media platforms used

List your profile/displayed name that you use with social media

What type of internet do you have at home for remote learning?

First Name

Last Name

Relationship

Address

City

State

Zip

Home Phone

(###) ###-####

Cell Phone

(###) ###-####

Email Address

First Name

Last Name

Relationship

Address

City

State

Zip

Home Phone

(###) ###-####

Cell Phone

(###) ###-####

Email Address