2021-2022 Device Request Form for NEST+m families

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Hi! This form is ONLY for requesting a remote learning device from NEST+m. If you need a device for your child, please continue filling out this form. Please note that the lending of all equipment is subject to availability.

However, if you're having tech problems, whether it's with equipment or logins, please go to https://docs.google.com/forms/d/e/1FAIpQLSedRhWn4ygsR5y2rLgaukbLgT_z9oqocf-aHfJQCnJ-pu8mxg/viewform

Student OSIS *

Student Name *

Student Date of Birth *

YYYY

Guardian Name *

Guardian email *

Guardian phone number *

Student address - Street, Apt, City *

Grade student will be in for 2021-2022 *

What type of device are you hoping to borrow? (If you're not needing a device, please don't fill out this form)

Do you have reliable internet access/wifi? *

Yes

Required

Is this request to replace an existing DOE/School device? *

Yes

If yes, please fill in the asset tag # of the device you have currently

Do you have any questions or comments? *

Submit

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