Tablet Request Form
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
School District or Agency with signed ETC loan agreement
*
School/Agency Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
Borrower Phone Number
*
Please enter a valid phone number.
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
Submit
Should be Empty: