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Student Electronic Learning Device Request

Please complete the form below. Required fields marked with an asterisk *

Parent/Guardian Information

Contact Information

Parent/Guardian First Name*

Answer required for "Parent/Guardian First Name"

Parent/Guardian Last Name*

Answer required for "Parent/Guardian Last Name"

Parent/Guardian Email*

Answer required for "Parent/Guardian Email"

Parent/Guardian Phone*

Number Required

Parent/Guardian Relationship to Student*

Answer required for "Parent/Guardian Relationship to Student"

Student Information

Student First Name*

Answer required for "Student First Name"

Student Last Name*

Answer required for "Student Last Name"

Student School Email Address (@nycstudents.net email)*

Answer required for "Student School Email Address (@nycstudents.net email)"

Student ID/OSIS Number*

Answer required for "Student ID/OSIS Number"

Grade level*

Answer required for "Grade level"

I understand that I am permitted only 1 device per student. I understand that the school has a record of all devices which were distributed, even those devices which were mailed home to families in the Spring of 2020. *

Answer required for "I understand that I am permitted only 1 device per student. I understand that the school has a record of all devices which were distributed, even those devices which were mailed home to families in the Spring of 2020. "

Yes

Once your request is processed, you will receive an email from [email protected] with subject "DEVICE FORM 208A". Print this form or go to room 208A to have it printed out for you. You will need to bring this form signed by a parent/guardian to room 208A to pick up your device.*

Answer required for "Once your request is processed, you will receive an email from [email protected] with subject \"DEVICE FORM 208A\". Print this form or go to room 208A to have it printed out for you. You will need to bring this form signed by a parent/guardian to room 208A to pick up your device."

Yes, once I receive the form, I will have the it signed by a parent/guardian and bring to room 208A to pick up a device.

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"