1:1 Technology Device Form 2017-2018
One form will need to be completed for each student. This form may be completed prior to device pick up. Your copy will be available for your signature when you arrive. This will expedite the process. To pay online visit
Student's Last Name
Student's First Name
Student's Graduation Year
2018 - Senior
2019 - Junior
2020 - Sophomore
2021 - Grade 9
2022 - Grade 8
2023 - Grade 7
Protection Plan Options
School District Protection $30 for 7-12 (covers 1 replacement-new policy may be purchased if coverage is used)
Device Will Remain In School-No Protection Option Needed
Personal Homeowner's Coverage-Proof of Policy must be provided at checkout
No Insurance (Full Deposit-$300 for Chromebook)
None needed, I will be using my own device.
Mobile Hotspot Checkout
Mobile hotspots are available for overnight check out from the Media Centers at the high school on a limited basis. It is the intention that these hotspots will be used for educational purposes. Hotspots will be configured with the school internet filter. This service is provided through a grant from MDE and is based on financial need and/or broadband availability.
Please email me an application and additional information.
We are not interested at this time.
Parent's Last Name
Parent's First Name
Parent Email Address
This email address will be used for an electronic receipt. If no email address is provided, we cannot send a receipt. Student email addresses may be used.
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This form was created inside of Pine City Public Schools, ISD #578.
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