Request Form for Kajeet SmartSpot (KMES)
Please complete this form to check out a mifi device for two weeks. Your request will be submitted to your Media Specialist for final approval. There is no cost to use the mifi device.
Email address *
Name *
Your answer
Grade Level *
Parent or Legal Guardian Information
***A parent's or guardian's signature is required before a student is issued a Mifi. ***
Name of Parent or Legal Guardian *
Your answer
Address *
Your answer
Best Contact Number for Parent or Legal Guardian *
Your answer
Student Confirmation
Please check Yes or No for each statement below.
I will safely secure the mifi device at all times. *
I will use the mifi device at home for educational purposes only and according to the Acceptable Use Policy. *
I will return the device to the Media Specialist within 1 week to inspect and to check out the device again if needed. *
I understand that if the mifi is damaged, stolen, or lost, a fee will be assessed based upon the following: Replacement (lost, damaged, stolen) Device - MiFi - ($100.00) Replacement of Charger and Cable ($20.00) *
A copy of your responses will be emailed to the address you provided.
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