Hotspot Request Form

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The Charleston R-I School District is offering a limited number of personal WiFi Hotspots for use by students who do not have reliable wireless Internet access for their Chromebook at home.

If you are interested in learning more, please visit charlestonbluejays.org/hotspots/.

Please complete the following form if you would like to request a Wi-Fi hotspot for your family.

Parent Name *

Parent Email *

Parent Phone Number *

Physical Home Address (not P.O. Box) *

List the name of each Charleston R-I student living in your home. *

Are you requesting a WiFi Hotspot for students to use in your home? *

Yes

Please indicate if any of the following apply to the Charleston R-I students residing in your home. (If approved, you may be asked to provide documentation of eligibility.) *

MEDICAID: card or most recent eligibility letter for any member of your household currently enrolled in the Charleston R-I School District.

HUD: Public housing assistance documentation such as your lease, housing assistance payment (HAP) contract, or eligibility documentation from HUD.

SNAP: letter indicating you are approved for Supplemental Nutrition Assistance Program benefits.

SSI: eligibility letter for Supplemental Security Income.

Homeless: One or more of the students in the household meets the legal definition of homeless according to the McKinney-Vento Act

None of the above are applicable

If you are approved for a hotspot but were required to pay $16 per month for the service, would you still be interested in the hotspot? *

Yes

When is the best time of day for school personnel to contact you to arrange pickup and complete paperwork, if approved? *

Morning (8am-Noon)

Afternoon (Noon-4pm)

Anytime

Please list any questions that you have about the hotspot program and a district employee may be in contact with you to answer your questions.

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