Blended Learning Tech Checkout

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

If you need to borrow technology for this event, you will need to complete this form for each child.

Technology will be sent home each day with your child. It must be brought back the next day fully charged.

Note: If you have several students and only need one device, select one child to bring home and return the tech each day.

Kindergarten will have iPads and 1st -12 have chromebooks. We will not be distributing technology for PK students at this time.

If you have questions about checking out equipment, please contact Tonya Dieken at tdieken@prairiecentral.org or call 815-692-2504.

Email *

Student Name: *

Parent Name: *

Phone number: *

Grade: *

Please be sure you are completing one form for each child in-person learning this fall and in need of technology at home.

Note: If you have several students and only need one device, select one child to bring home and return the tech each day.

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Prairie Central CUSD #8. Report Abuse

Forms