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Chrome Book/ Hotspot Program
Please answer all questions on this form. Once you complete the form, please take this chrome book to a school representative to finish the form and receive your device.
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* Indicates required question
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student Grade Level
*
K
1
2
3
4
5
6
7
8
9
10
11
12
Parent/ Guardian First Name
*
Your answer
Parent/ Guardian Last Name
*
Your answer
Parent/ Guardian E-mail Address
*
Your answer
Parent/ Guardian Phone Number
*
Your answer
Device Receiving (TO BE FILL OUT BY SCHOOL REPRESENTATIVE)
*
Hotspot
HP
Samsung
Device Number (TO BE FILL OUT BY SCHOOL REPRESENTATIVE)
*
Your answer
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