Internet HotSpot Application - English

Parents/Guardians,

Parent/Guardian Last Name *

Parent/Guardian First Name *

Parent/Guardian Email Address *

Parent/Guardian Phone Number *

Parent/Guardian Street Address and ZIP Code *

Do you have access to wireless broadband internet in your home (NOT a cell phone or a hotpot)? *

How many District 86 students reside in your household? *

Student #1 Full Name *

Student #1 School *

Student #1 Grade Level *

Student #2 Full Name

Student #2 School

Student #2 Grade Level

Student #3 Full Name

Student #3 School

Student #3 Grade Level

Did any student in your household receive a District 86 Hotspot LAST school year? *

If YES, please indicate the student's name.

If YES, Do you still have the Hotspot from last year?

If you do not still have the Hotspot, what building did you turn it in to?