MOE Modem activations and returns
This form is to be used by Stepping UP partners who are assisting families activate or return modems issued by the Ministry of Education during the Covid-19 lockdowns. The information will be used to ensure that unwanted modems are returned for use by other households that do not have an internet connection.

Please answer the following questions (mandatory questions are marked with an asterisk).

By providing an email address below you will receive an automated copy of your responses.
Sign in to Google to save your progress. Learn more
Email *
Stepping UP Partner Organisation *
Modem IMEI/serial number (or other unique identifier): *
Name of person seeking assistance or returning a modem? *
Name of student (if modem was issued to a particular student)
Current address (number and street) *
Suburb or rural delivery number
City or Town *
Post code
Contact phone number
What school does the eldest child in the household attend, if known? (or enter 'not known') *
What assistance are you providing?
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Digital Inclusion Alliance Aotearoa. Report Abuse