Distance Learning Technology Device Request for Early Childhood- Grade 6 families
As we plan for Fall 2020 learning options , all families may choose a full time distance learning option. If your family does not have access to high speed Internet or if one or more of your children need a technology device to support distance learning, please complete this form. You should complete the form individually for each child so we can best address your individual technology needs.

Student First Name (please enter legal name- not nickname) *
Student Last Name *
Student Birthday by month, date, year, For example 09/08/2010. *
MM
/
DD
/
YYYY
School *
Grade *
Do you need a technology device for your child in to access distance learning?
Clear selection
If you have a student in grades 7-12 they will receive an iPad. You do not need to request a school devices for students in these grades.
Do you need wi-fi Internet access for your home? To support distance learning high speed Internet access is needed. Internet access on a cell phone is not sufficient.
Clear selection
If you have more than one child that needs a technology devices please complete a survey for EACH child with their name.
Contact email address or phone number *
Is there anything else you want us to know?
If you have questions related to technology and distance learning please email disttech@isd623.org or call 651-604-1435. Thank you.
Submit
Never submit passwords through Google Forms.
This form was created inside of Roseville Area Schools. Report Abuse