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TECHNOLOGY REQUEST (virtual learning)
Please complete this form to indicate support needed from the DATE technology department.
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* Indicates required question
Email
*
Your email
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
Parent's Last Name
*
Your answer
Parent's First Name
*
Your answer
Parent's Email Address
*
Your answer
Parent's Cell Phone Number
*
Your answer
I need to get assistance with technology:
*
Choose
I am requesting a device for my child
I have a device that is not working properly
Have you paid the $25 insurance deposit for devices?
*
Choose
Yes
No
I have a request that is not listed:
*
Your answer
Send me a copy of my responses.
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