Inclusive Education Technology Request Form

Student Name, Grade, and School Year

Teachers Name*

First Name Last Name

School Year*

Grade*

Is this student in good standing?*

Yes
No

Is this Equipment being sent out or picked up*

Picked up at Nelson office
Being shipped to family
Other

If you picked Other please specify

Microsoft Office License OR Student Email

Would you like to include a Microsoft Office License?*

Yes
No

Please note: the Microsoft Office license is an additional $30/year and is a yearly recurring subscription for as long as it remains in use.

Would you like a CHEK ABC student email created? (Free)*

Yes
No

Creating a student email with CHEK ABC will give you access to your own personal drive in which you can use Google Docs, Google Sheets, Google Slides, etc. Students will also be able to share and store their documents on the drive.

Agreement

I will comply with the terms and conditions of the Computer Lease Program. After 30 days from from the receipt of the computer, I will assume full responsibility for technical support and maintenance for the computer. If I leave CHEK ABC before the lease period is up, I agree to pay the remainder of the lease amount in full.

Yes. I agree to the Terms and Conditions of the Computer Lease Agreement
No. I not agree to the Terms and Conditions of the Computer Lease Agreement

Please type your full legal name to the above statement. Typed names suffice as handwritten signatures.