Request Form for Kajeet SmartSpot (GES)
Please complete this form to check out a Kajeet SmartSpot for one week. Your request will be submitted to your Media Specialist for final approval. There is no cost to use the SmartSpot.
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 Kajeet SmartSpot at all times. *
Required
I will use the SmartSpot at home for educational purposes only and according to the Acceptable Use Policy. *
Required
I will return the device to the Media Specialist within 1 week to inspect and to check out the device again if needed. *
Required
I understand that if the Kajeet SmartSpot is damaged, stolen, or lost, a fee will be assessed based upon the indicated: Replacement of Kajeet SmartSpot (lost, damaged, or stolen) - $100.00; Replacement of Charger and Cable - $20.00 *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Fairfield County School District.