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PLR Virtual Learning Technology Request
PLEASE ONLY SUBMIT THIS FORM ONCE PER FAMILY. ALL CHILDREN FROM THE SAME FAMILY SHOULD BE LISTED ON ONE FORM.
Duplicate requests will slow down the distribution process.
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* Indicates required question
Email
*
Your email
Name of parent/guardian making this request
*
Your answer
Phone number of parent/guardian making this request
*
Your answer
Email address of parent/guardian making this request
*
Your answer
First name & last name and grade of Student #1 who requires a Chromebook
*
Your answer
First name & last name and grade of Student #2 who requires a Chromebook (if applicable)
Your answer
First name & last name and grade of Student #3 who requires a Chromebook (if applicable)
Your answer
First name & last name and grade of Student #4 who requires a Chromebook (if applicable).
Your answer
How many devices are you requesting in total for your family? (one per student maximum)
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1
2
3
4
I understand that the device is on loan and that it will need to be returned to P. L. Robertson in good working order. Chromebooks must be returned to the school within two days of a return to face to face learning.
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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