West Allegheny Remote Learning - Technology Device Request

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NOTE: Please complete one form for each student who requires a device.

Email *

Parent/Guardian First Name *

Parent/Guardian Last Name *

Phone Number *

Street Address *

Street Address

Student School *

High School

Middle School

Donaldson Elementary

McKee Elementary

Wilson Elementary

Student Grade Level *

K-2

3-5

6-8

9-12

Student First Name *

Student Last Name *

Preferred Device Pickup Date *

I have read and agree to the Technology Device Agreement. Please click here to read the agreement: http://www.westasd.org/Downloads/Technology%20Device%20Agreement.pdf *

Yes

Send me a copy of my responses.

Submit

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