Computer Request - Maritime OnlIne School - The Maritime Academy of Toledo

Computer Form Title

Instructions

Name of Student (Please fill out a separate form for each student in your household.)

First Name of Parent/Guardian

Last Name of Parent/Guardian

Address Line 1

Address Line 2

City

State

Zip

Email Address of Parent/Guardian

Phone Number of Parent/Guardian

Special Requests (SPECIFY WHETHER A COMPUTER, HOTSPOT, OR BOTH ARE REQUIRED)