Device Request Form

Student's First Name *

Student's Last Name *

Student ID Number

If you do not know your student's ID number, leave this blank

Grade *

Select your student's grade for the 2020-21 school year

School *

Select your student's school for the 2020-21 school year

Parent/Guardian First Name *

Parent/Guardian Last Name *

Parent/Guardian Email *

Parent/Guardian Phone Number *

Area Code Phone Number

Do you have internet access? *

Yes No

Do you need a hotspot? *

Yes No

Does your student already have a Northshore School District device? *

Yes No

Tell us more about why you're requesting another device? *

The device I have isn't working The device I have doesn't meet my student's grade-level needs

Are you requesting a device for Highly Capable Screening and Assessment? *

Yes No

Student Technology Equipment Use Agreement

This agreement is to be used when issuing a Northshore School District device or other technology for use by a student at home. Use of any technology in the context of teaching and learning is governed by the guidelines and expectations set forth in the NSD Responsible Use Procedure (RUP). Access to NSD technology is a privilege, not a right, and as such, students and guardians must seriously consider the responsibilities associated with the opportunity to use technology devoted to activities that support learning.

We understand that the student takes full responsibility for the issued device and related accessories, and the school is not responsible for the security and safety of the student-issued device.
We understand that the student and guardian(s) may be held financially responsible for the repair or replacement of any part of the device and its accessories, should damage or loss occur.
We understand that if the device is stolen, damaged, or lost, the student shall make every reasonable effort to notify school staff as soon as possible.
We understand that the student will use the device in ways consistent with the Northshore School District Responsible Use Procedure (2022P) and will use the device only for school-related purposes.
We understand that when the device is connected to a non-Northshore wireless network, such as home or business wifi, that the monitoring of internet content is the duty of the parent or guardian and that internet activity is only filtered when on school grounds and connected to Northshore SD wireless networks.
We understand the expectations for device care:
- Student will not leave the device unattended at any time while at school orin a public place.
- Student will not remove the District barcode labels or mark the device in any way with markers, stickers, scratches, engravings, etc.
- Student will not remove the hard drive and/or modify the device’s operating system in any way.
- Student will not install any unauthorized software or browser extensions.
We understand that the student may lose his/her technology equipment privileges as a result of inappropriate behavior, damage, neglect, or loss.

By typing your name, you agree to all of the above statements. *

First Name Last Name