Device Request Form
Technology & Innovation staff are preparing to make Chromebooks available to elementary school students who do not have access to computers within the home during the current closure related to COVID-19.

Families of elementary students that do not have access to a laptop computer, desktop computer, or tablet in the home should complete this request form, after which you will be contacted with instructions for picking up the device. We ask that requests be made by families who lack computing resources at home, as we wish to ensure that devices are available to all families in need of service.

Devices are limited to one per elementary student and the form should be filled out for each student. Any questions about this form can be directed to
Parent/Guardian Email Address *
Your answer
Student's Last Name *
Your answer
Student's First Name *
Your answer
Student's ICCSD Email ( *
Enter student's grade level if email address is unknown.
Your answer
What school does the student attend? *
Please provide your contact information. This will be used to schedule device pick up. *
Your answer
Please submit an additional form if you are requesting devices for more than one student.
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