Student Information

Last Name

First Name

SF ID #

SF Email address (please provide only your official college email address)

Campus Location Preference for Pickup

By selecting this campus, you are indicating that—if approved—this is where you would like to pick up your loaner technology. Please make sure you choose the location that is most convenient for you.

Enrollment Verification

Are you currently-enrolled in credit-bearing classes?

Technology Request

Which technology do you need? Check all that apply

LaptopWi-Fi HotspotWebcamOther

if Other, please specify:

Do you currently have access to any of these items?

Have you applied for Financial Aid (i.e. completed FAFSA)?

Have you completed the Bookstore Payment Authorization?

Narrative (Required)

Please explain your situation in detail (minimum 150 words); include: ---why you need this technology for your classes ---why you cannot purchase or access it through the bookstore or other means ---any financial challenges you are facing

Agreement

“I understand that completing this form does not guarantee approval. If approved, I must also complete the Basic Needs Survey and return all equipment by the end of the semester, or as soon as I withdraw, drop or am no longer enrolled in the course.”

I agree