HotSpot Application For Families
We understand that all families do not have internet access at home. PCPS is committed to providing the necessary tools to ensure equity of access for all students. Priority will be determined based on need and availability.

In order for the hotspot to work, you must have cell coverage in your area. This does not require a cell phone or plan, but cell phone coverage must be available for the hotspot to work.
List first and last names of all students living in the home. *
Please enter your home address (physical 911 address, not mailing address). *
At your home, is there a cell phone signal available? A cell plan is not required, but your area must have cell phone capability in order for the hotspot to work. *
Do you currently have internet service at your home? *
Please describe your need for a hotspot. *
Schools attended. Check all that apply *
Required
Parent to contact: *
Phone number for parent: *
I understand that if my family is issued a hotspot in order for my student(s) to complete school work that I am taking responsibility for the hardware/device. I agree that if the hotspot is lost, stolen, or damaged, I will be responsible for its replacement cost (approximately $60). I also understand that the device may be revoked due to lack of use or not completing assignments. *
Submit
Never submit passwords through Google Forms.
This form was created inside of Patrick County Public Schools. Report Abuse