Tablet Request Form

Tablet Request Form
Date*

MonthDayYear
Date
Name*

First NameLast Name
School District or Agency with signed ETC loan agreement*
School/Agency Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Borrower Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Borrower Email Address*
example@example.com
Please add any additional instructions or comments here
Device*
iPad Apps

Please select up to 10 apps below for iPads ONLY
App-Choice 1*
App-Choice 2
App-Choice 3
App-Choice 4
App-Choice 5
App-Choice 6
App-Choice 7
App-Choice 8
App-Choice 9
App-Choice 10
Should be Empty:

iPad Apps