BCSD - Mobile Hotspot Application

BCSD - Mobile Hotspot Application

District-Owned Devices (For those that do not qualify under Act 142)
Beaufort County School District has access to some Kajeet Mifi Hotspot devices available for check-out and use based on the following criteria:
1. A student or employee of Beaufort County School District must reside in your household.
2. Households must show an outstanding need that has hindered either wifi access or financial difficulties.
3. There is currently no internet service in the household.
If you feel you meet these criteria and want to apply to receive a BCSD Mobile Hotspot for use for remote learning/teaching, please answer the following questions.
I am a(n): *

Employee completing on behalf of my household Employee completing on behalf of a student/family Parent or Guardian of BCSD Student
Employee Name: *

First Name Last Name
Employee BCSD Email Address: *
example@example.com
Employee Phone Number: *
Please enter a valid phone number.
Location of Employment: *
Parent/Guardian Name *

First Name Last Name
Parent/Guardian Email Address
example@example.com
Parent/Guardian Phone Number *
Please enter a valid phone number.
Preferred method of contact: *

Phone Email

Is there currently internet service in your household? *

Yes No
No existing internet service due to: *

There are no internet providers currently providing coverage at the location of my household. I cannot afford the cost of internet service for my household All of the Above
Physical Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Reason requesting BCSD Mifi Hotspot (Check all that apply) *

Financial Hardship Geographic Hardship Other
Additional Details/List Reasons: *
ACKNOWLEDGEMENT

By submitting this form, you certify all responses to be true and allow BCSD to verify enrollment and specifics as needed.

Mobile hotspots will be assigned to the employee or the oldest BCSD student in your household and will be issued once the devices are onsite and configured. Please ensure your contact information is current so you may be contacted for questions and pick up information.
Employee or Parent/Guardian Signature *

Clear
Principal Signature *

Clear

Should you have any further questions, please direct them to your school social workers.

Thank you.
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