Student FIRST Name (Note: Devices are limited to 1 per household, so if you have multiple children, just list one of your children here. You do not need to fill this form out multiple times for each child.) *
Your answer
Student LAST Name (Note: Devices are limited to 1 per household, so if you have multiple children, just list one of your children here. You do not need to fill this form out multiple times for each child.) *
Your answer
What school does your child attend? *
Choose
Anderson
Ayer
Maddux
Mercer
Nagel
Sherwood
Summit
Turpin
Wilson
I am requesting a school device to be provided for my child while learning takes place online at home. *
Submit
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