SPANISH Home Use Agreement Wizard

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Use this form to generate a student-specific agreement form in SPANISH for any students who may need to use AT devices at home during the school year. Please DO NOT send any devices home before this agreement is signed by the family and by your school administrator. Schools still take on the financial liability for devices in the home unless the school comes to another agreement with the family, so it is imperative that your school administrator be consulted before home use is offered.

**All AT Equipment is still due back to 780 Grant Street by the end of the school year. This agreement does not allow for summer home use.**

Student Name *

Student ID Number *

Name of Parent or Guardian *

School Name *

School Representative Name *

School Representative Email Address *

School Representative Phone Number *

Equipment 1 Name *

AT Number for Equipment 1 *

Barcode Number for Equipment 1 *

Equipment 2 Name *

If the student will only be taking one item home, please enter N/A.

AT Number for Equipment 2 *

If the student will only be taking one item home, please enter N/A.

Barcode Number for Equipment 2 *

If the student will only be taking one item home, please enter N/A.

Start Date *

This is the date that home use was approved.

YYYY

Home Use Begin Date *

This is the date the item is expected to be taken home for the first time.

YYYY

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