HSA Houston Student Chromebook Request FORM
Goal: Expand Distance Learning Opportunities for students who need technology at home

Harmony Public Schools is committed to helping students and their teachers continue learning outside of school. Students with no technology devices available for at-home learning may receive a Chromebook for their use at home. The limit for checkout is one device per Harmony family.

Please submit your request as soon as possible as devices will be issued on a first-come, first-served basis. You will receive a confirmation email and instructions on next steps once your form has been received.
Email address *
Please submit your request as soon as possible as devices will be issued on a first-come, first-served basis. You will receive a confirmation email and instructions on next steps once your form has been received.
The student must be present at the time of issuing the device, and student ID numbers will be verified in advance of pick-up to ensure the student is currently enrolled in HPS.
Student's FIRST name ? *
Your answer
Student's LAST name ? *
Your answer
Student's date of birth? *
MM
/
DD
/
YYYY
Skyward Student Number ? *
Your answer
Student's GRADE LEVEL ? *
What is the home address of the enrolled student? *
Your answer
What is a good email address where we can contact you? *
Your answer
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