Laptop Request
Student Full Name
Grade Level
School Name
Parent/Guardian Full Name
Contact Email Address
Phone Number (with area code)
Home Address (optional)
Do you currently have access to a laptop or tablet?
-- Select --
No
Yes, but it is shared
Yes, but it is broken
Number of children in household
Do you have internet access at home?
-- Select --
Yes
No
Sometimes / Mobile Hotspot
Reason You Need This Laptop
I certify that the information provided is true and this request is for a real student in my household.
Submit Laptop Request