Device Request Form

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Device Request Form

Fill out the information below if you are a Messmer family and need a Chromebook or hotspot.

* Indicates required question

School *

Choose

Messmer High School

Messmer Saint Mary

Messmer Saint Rose

Student Last Name *

Your answer

Student First Name *

Your answer

Student Grade Level *

Choose

K4

K5

1

2

3

4

5

6

7

8

9

10

11

12

Do siblings of the list student also need a device? *

Choose

Yes

No

What device do you need? *

Hotspot

Chromebook

Both

Parent/Guardian Name *

Your answer

Contact Number *

Your answer

Submit

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