De Queen Student Request for Verizon Internet Hot Spot (Mifi access point)
Sign in to Google to save your progress. Learn more
Parents phone number *
De Queen Student name *
Parent or Guardian Last Name: *
Parent or Guardian First Name: *
Number of ELEMENTARY students (K-5) in the home: *
Number of MIDDLE SCHOOL students (6-8) in the home: *
Number of HIGH SCHOOL students (9-12) in the home: *
Does the house currently have access to fixed internet? (DSL, Satellite,  Windstream) NOT INCLUDING CELL PHONE ONLY ACCESS *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of De Queen Public School District. Report Abuse