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Chromebook Checkout Request
Home technology needs questionnaire
Student First Name *
Your answer
Student Last Name *
Your answer
Student ID Number *
Your answer
Grade Level *
Please choose the option that best describes your access to an internet connected device (tablet, computer, etc.) at home *
If you selected "I have my own personal device(s)" for the last item, please indicate the type of device(s) below. Select all that apply *
Do you have reliable fast internet access at home or somewhere you are able to regularly access (reliable enough that you don’t have to think about whether it will work when you need it to work)? *
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