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Student Electronic Learning Device Request

Please complete the form below. Required fields marked with an asterisk *

Parent/Guardian Information

Contact Information
Parent/Guardian Relationship to Student*
Answer required for "Parent/Guardian Relationship to Student"
Does the student have access to a computer?*
Answer required for "Does the student have access to a computer?"
Does the student have internet access?*
Answer required for "Does the student have internet access?"

Student Information

 
Grade level*
Answer required for "Grade level"
I understand that I am permitted only 1 device per student. I understand that the school has a record of all devices which were distributed, even those devices which were mailed home to families in the Spring of 2020. *
Answer required for "I understand that I am permitted only 1 device per student. I understand that the school has a record of all devices which were distributed, even those devices which were mailed home to families in the Spring of 2020. "
I prefer the following device:*
Answer required for "I prefer the following device:"
I understand that once my request is processed, I will receive an email with subject "DEVICE FORM 208A". I will go to room 208A to pick up my "STUDENT DEVICE LOAN TERMS OF USE" form. I will bring the form back the following day to pick up my school device.*
Answer required for "I understand that once my request is processed, I will receive an email with subject \"DEVICE FORM 208A\". I will go to room 208A to pick up my \"STUDENT DEVICE LOAN TERMS OF USE\" form. I will bring the form back the following day to pick up my school device."
Confirmation Email