Harelson Chromebook Request

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Please fill out one for each student in need of a Chromebook. You only need too complete this form once, per child. Please do not fill out multiple requests for the same child as it will slow down the process. As we receive more chromebooks we will contact families who are next in line to receive a device. Thank you!

Student's First Name *

Student's Last Name *

Will your child attend as a Harelson Student or Amphi Academy Online student. *

Harelson Student (online until determined safe to return)

Amphi Academy Online Full Year (Only choose this option if you already filled out online form. Non-Harelson student

Parent's First Name *

Parent's Last Name *

A good phone number to reach you at: *

Parent's email Address *

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