Centerpoint Student Request for Verizon Internet Hot Spot (Mifi access point)
Primary Parent or Guardian Last Name: *
Primary Parent or Guardian First Name: *
Primary Parent or Guardian Phone Number: *
Primary Parent or Guardian Email Address: *
List the FIRST and LAST name of all Centerpoint students living in the household (Example: John Doe, Jane Doe) *
Number of ELEMENTARY students (K-5) in the home: *
Number of MIDDLE SCHOOL students (6-8) in the home: *
Number of HIGH SCHOOL students (9-12) in the home: *
Does the house currently have access to fixed internet? (DSL, Satellite, or South Central Connect) NOT INCLUDING CELL PHONE ONLY ACCESS *
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