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CBK Student Computer, Wifi, Textbook, IDs, and Other Supplies
Please complete this form and we will call, or email you with a time and location to pick up a computer and or Wifi device.
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First Name
*
Your answer
Last Name
*
Your answer
Email (please check your email after submitting this form)
*
Your answer
Phone Number
*
Your answer
Alternate method to contact you. Either email or phone number
Your answer
CBK Site You Attend
*
Choose
Arlington RLC Riverside
Betty Gibbel RLC San Jacinto
Corona
David Long RLC Murrieta
Desert Hot Springs
Don F. Kenny Indio
Lake Elsinore Planet Youth
Empower Youth Hemet
EOC Riverside
Grindstaff Riverside
Jurupa
La Quinta Desert Flow Center
Mead Valley Library
Mecca Boys n Girls Club
Milo P. Johnson
Moreno Valley RLC
Palm Springs
Perris
Riverside YOC Bobby Bonds Center
Rubidoux YOC
SCE School of Career Education Moreno Valley
Val Verde RLC
Other
Do you need a computer?
Yes
No
Do you need a WiFi Hotspot?
Yes
No
Do you need a textbook? Please ask your teacher which books you need and list them here.
Your answer
Do you need a CBK student ID?
yes
No
Graduates Only: Do you need an appointment to pick up your diploma?
yes
No
Other requests or comments
Your answer
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