Serve Your City & Ward-6 Mutual Aid Network Digital Device Request Form
Thank you so much for reaching out to Serve Your City and the Ward-6 Mutual Aid Network to request a digital device. Please fill out the following form with your information. Filling out this form does not mean that you are guaranteed a digital device. If we are able to provide you with one, we will be in touch.

Muchas gracias por comunicarse con Serve Your City y Ward-6 Mutual Aid Network para solicitar un dispositivo digital. Por favor complete el siguiente formulario con sus datos. Completar este formulario no significa que se le garantice un dispositivo digital. Si podemos proporcionarle uno, nos pondremos en contacto.
Full Name /Nombre *
Email Address / Correo Electrónico *
Phone Number/ Número de teléfono *
Ward / Distrito *
Do you have access to the Internet? / ¿Tiene acceso a Internet? *
Is this device for a Student or an Adult? / ¿Este dispositivo es para un estudiante o un adulto? *
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