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Request for electronic devices on loan for distance learning activities
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* Indicates required question
I (write NAME and SURNAME)
*
Your answer
Parent of the pupil(s) (in case of several children attending our institution write all their names)
*
Your answer
Who attend(s) the following school(s) (in case of more than one child select more than one box)
*
Scuola primaria di Bordolano
Scuola primaria di Casalbuttano
Scuola primaria di Robecco D'Oglio
Scuola secondaria di Casalbuttano
Scuola secondaria di Robecco D'Oglio
Required
AWARE OF THE SANCTIONS PROVIDED FOR BY ART. 76 OF D.P.R. 445/2000 IN CASE OF UNTRUE STATEMENTS
DECLARE
The need for loaning
*
An electronic device (PC or tablet)
A modem for internet connection (the SIM must be purchased by the borrower)
Both
To have an ISEE income of
*
Less than 10.000 €
Between €10,000 and €15,000
Over 15.000 €
I ALSO DECLARE THE FOLLOWING INFORMATION
Number of children attending the middle school (scuola media)
*
None
1
2
3
Other:
Number of children attending the 4th or 5th class of primary school
*
None
1
2
3
Other:
Number of children attending the 3rd class of primary school
*
None
1
2
3
Other:
Number of children attending the 1st or 2nd class of primary school
*
None
1
2
3
Other:
Number of children attending high secondary school (scuola superiore)
*
None
1
2
3
Other:
Pupil(s) with disabilities (Law 104)
*
Yes
No
Number of family members
*
3 (with a child)
3 (with two children)
4
5
6
Other:
Number of smartphones owned by the family
*
None
1
2
3
Other:
Number of tablets owned by the family
*
None
1
2
3
Other:
Number of PCs owned by the family
*
None
1
2
3
Other:
Parents in smart working
*
None
One of the parents in smart working with his/her own device
Both parents in smart working with their own device
Other:
IF I AM AWARDED, I AM AWARE THAT:
THE DEVICE MUST BE USED EXCLUSIVELY FOR CARRYING OUT ACTIVITIES RELATED TO DISTANCE LEARNING
IN CASE OF LOSS, THEFT OR BREAKAGE OF THE DEVICE IT WILL BE THE BORROWER’S RESPONSIBILITY TO REPAY FOR IT ACCORDING TO ITS COMMERCIAL VALUE
IF TEACHERS FIND OUT THAT THE STUDENT DOES NOT PARTICIPATE IN DISTANCE LEARNING ACTIVITIES AND/OR DOES NOT DILIGENTLY CARRY OUT THE ASSIGNED TASKS, THEY WILL REQUEST THE IMMEDIATE RETURN OF THE DEVICE
AT THE END OF THE PLANNED LOAN PERIOD, DEVICES SHOULD BE RETURNED TO THE SCHOOL IN THEIR INITIAL CONDITIONS
SINCERELY
THE STUDENT'S PARENT.
Phone number
*
Your answer
Possible e-mail address
Your answer
Delivery address: VIA / PIAZZA
*
Your answer
Delivery address: CIVIC NUMBER
*
Your answer
Delivery address: CITY
*
Your answer
Delivery address: ZIP code
*
Your answer
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