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Mobile Internet Hotspot Loan Request
Mobile hotspots will be loaned to student families based on need as outlined by Federal Guidelines.
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Email
*
Your email
1. What is the parent's first name?
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Your answer
2. What is the parent's last name?
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Your answer
3. What is the student's first name?
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Your answer
4. What is the student's last name?
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Your answer
5. What school does this student attend?
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Brookport Elementary
Franklin Elementary
Jefferson Elementary
Massac County High School
Massac Junior High School
Metropolis Elementary
Unity Elementary
6. Do you have other children (family or non-family) that live in your house that attend this or other Massac Unit #1 schools.
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Yes
No
7. If you answered "YES" to question #6, how many children attend this or other Massac Unit #1 schools?
1
2
3
4
5
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8
9
Clear selection
Do you currently have home Internet access?
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Yes
No
If you answered no above, which of the following is the primary reason that you do not currently have home Internet?
Cost
Physical location of home
Other:
Clear selection
What is your total (gross) monthly household income?
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Your answer
How many total household members?
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Your answer
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