HotSpot Loaner Request

Name *

First Name Last Name

Mid Student ID Number *

This can be found on your Student ID card or in your MidWeb account.

MidMich Email *

example@midmich.edu

Phone Number *

Area Code Phone Number

Current Address (or Address where HotSpot will be used) *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Do you currently have internet access? *

Yes No

Who is your current internet service provider?

Examples: Verizon, Charter, etc.

Briefly explain your need for a Mid Michigan College HotSpot Device and how it would help you achieve educational success. *

Where would you like to pick up your HotSpot Device? *

Harrison Campus Mt. Pleasant Campus

Signature *

Clear

Today's Date *

Month Day Year

Significant effort has been made to ensure this content meets accessibility guidelines. If you encounter a barrier you can report the barrier at midmich.edu/reportaccessibilitybarrier or contact Student Wellness & Equity at (989) 386-6622 x256 or wellness@midmich.edu.

Mid Michigan College strongly endeavors to broaden our diversity, promote equal opportunity, and provide a safe environment within its community. Mid is an equal opportunity employer and educational institution that prohibits any form of discrimination against any person on the basis of race, color, religion, sex, gender identity or expression, pregnancy, age, sexual orientation, marital or parental status, national origin, citizenship, genetics, disability, military/veteran status, or any other legally-protected status. This applies to the administration of and access to the College’s programs and activities; scholarship and loan programs; athletics; and in conditions of admission or employment. To learn more please see the Campus Non-Discrimination, Harassment, and Sexual Misconduct Policy at midmich.edu/titleix, and the Equal Employment Opportunity Policy at midmich.edu/eeo. Additionally, the College publishes an Annual Security that outlines safety and security initiatives, policies, protocols, and crime statistics and is available at midmich.edu/securityreport.

Mid strongly encourages anyone who observes or experiences any acts harassment, discrimination, inequitable treatment, or sexual misconduct to report the incident and seek assistance from one of the College’s Title IX/Civil Rights Coordinators as follows:

For Students

Kim Barnes, AVP of Security Operations and Systems/Chief Title IX Coordinator, 2600 S. Summerton Rd., Mt. Pleasant, MI 48858, (989) 386-6622 x236, kbarnes@midmich.edu

Tricia Farrell, Director of Security Operations and Systems/Deputy Title IX Coordinator, 1375 S. Clare Ave, Harrison, MI 48625, (989) 386-6622 x394, mfarrell@midmich.edu

For Employees

Lori Fassett, AVP of Human Resources/Title IX and Civil Rights Coordinator, 1375 S. Clare Ave, Harrison, MI 48625, (989) 386-6692, lfassett1@midmich.edu