Device Request

"*" indicates required fields

Parent Name*

First Last

Please list the name of the parent/guardian that completed the enrollment application.

Email*

Phone*

Shipping Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please list an address where someone will be available when item(s) are delivered if possible.

Do you need an internet device (mifi)?*

Yes

Number of Chromebooks Requested

Name of Student(s)*

List the name(s) of the student(s) that are requesting a Chromebook

This field is for validation purposes and should be left unchanged.