Device Request Form

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Device Request Form

AT THIS MOMENT, WE ARE ONLY GIVING OUT IPADS AND HOTSPOTS WHERE APPROVED.

This is a request form for students in ALL grades. These devices are being distributed with the intent that you need a dedicated device to work on at home. The device is intended and recommended to remain home.

Once verified, you will receive an email telling you when and where to pick up a device. The device will be a Chromebook. Important - the Chromebook does not have its own internal data service. It has to be connected to an outside WiFi source to operate. If you need a device with data service, we can issue you an IPad with a keyboard instead. Additionally, any lost or damaged devices will not be replaced. You must be careful and responsible with these devices. The devices are expected to be returned in June of 2022.

You MUST fill out this form completely and truthfully. The order in which you fill it out will not matter. It is NOT first come, first serve.

Last Name *

First name *

OSIS *

Official Class *

Grade Level *

What device are you requesting ? *

IPad

Hotspot

Do you have internet access at home ? (this does not disqualify you from getting a device - but these laptops do NOT have their own WiFi) *

Yes

Do you have a device that you can use at home (this does not disqualify you from getting a device) *

Yes

Do you have a DOE Ipad ? (this will not disqualify you from getting a device)

Yes

Clear selection

What is your DOE email ? *

What is the name of your parent or guardian ? *

What is the best phone number to contact your parent or guardian ? *

What is your lunch period ? *

Will you need a HotSpot to use at home in order to use the Chromebook ? *

Yes

This device is a loan from Midwood HS. If you receive a device, and it is broken while in your possession, you will most likely NOT receive a replacement. Additionally, all students will be asked to return the device in June. If you are leaving Midwood to attend another school, you also have to return the device. The device should only be used for school work, and it should be kept home. Do you understand the following expectations ? *

Yes

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