Device Request Form Fall 2022-2023
Fill out this form if you need a device to use at home during remote learning. Please note, this request will only be processed if you have NOT already borrowed a device from the school or the DOE. You will be contacted when the device is ready for pickup.
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Email *
Student First Name *
Please put your first name only. No nicknames or initials
Student Last Name *
Please put your last name only. No nicknames or initials
Student Grade Level *
Parent Last Name *
Please put your last name only. No nicknames or initials
Parent First Name *
Please put your last name only. No nicknames or initials
CHA Email Address *
If you do not have a CHA email address yet, please provide your DOE @nycstudents.net email address is possible.
Is this device request for a new device or a replacement device? *
Select replacement device if you already have a device but need a replacement one because the other device is either not working or damaged.
If this is a replacement device for a DOE-issued laptop/ipad, please describe the issue below in detail.
Do you have WiFi at home? *
Please contact the school at (718) 736-7320 to schedule an appointment to pick up your laptop.
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