Student Loaner Laptop Request Form

Use this form to request a loaner laptop for the period in which students will be learning remotely due to the COVID-19 pandemic.

First Name *
Last Name *
PID *
Email *
After Winder Quarter Finals, where will you be staying? *

After Winder Quarter Finals, where will you be staying? On Campus Off Campus
If you are staying off campus, what is the address?
Do you have a mobile phone? *

Do you have a mobile phone? Yes No
If you have a mobile phone what carrier do you use?
Do you have a tablet (iPad, etc.)? *

Do you have a tablet (iPad, etc.)? Yes No
If you have a tablet, list the internet options below.

If you have a tablet, list the internet options below. Wi-fi only Wi-fi plus cellular
Do you have internet access where you are staying after Winter Quarter? *

Do you have internet access where you are staying after Winter Quarter? Yes No
If you will have internet access, provide the connection speed if you know it.
List any other existing computer or workstation you may have access to after Winter Quarter.