PS 23 Parent Technology Device Request Form

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PS 23 Parent Technology Device Request Form

Please read the following: Technology Equipment Loan Agreement. By completing this form, you acknowledge that you have read, understand and agree to the entire Agreement and Acceptable Use Policy, including the requirement to pay Jersey City Public Schools $100 for each device lost, stolen, damaged, or not returned in the same good working condition as received.

Please fill out one form per student request.

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* Indicates required question

Name of the Parent/ Guardian requesting the device: *

Your answer

Household Address *

Your answer

Contact phone number? *

Your answer

Student Name (First, Last)

Your answer

Student Homeroom

Your answer

Submit

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