Remote Learning Request Form

Please complete this form to request mobile data, broadband and/or device support for your child’s home learning during the Coronavirus school closure period.

You will need to complete one form per family. To help us with your application please fill in as much information as possible.

Please note, we have a limited number of devices available to loan, therefore we will need to prioritise how they are allocated which in the first instance will be to those students defined as vulnerable and/or disadvantaged using the government’s current guidance. Please return your completed applications before the end of the day Thursday 14^th January 2021.

By loaning a device, you will be agreeing to take full responsibility for all equipment issued to you by Urchfont Primary School. We will require you collect the device and to sign our “Loan Agreement” before you can take a loan device home, a copy of this agreement will be available on our website.

Please tell us your full name

What year group is your child in?

Please tell us your child/ren's name

Please provide your contact number

Please provide your email address

Do you currently have Broadband at home? Yes No

If no, can you access the internet via a mobile device? N/A Yes No

If you are requesting an increase to mobile phone data allowances please complete the following:

Name of Mobile Phone Account Holder

Number of the Mobile Device

The name of the mobile network provider (e.g. Three, TescoMobile)

If you are requesting to loan a device please tell us why your child/ren needs to borrow a device from the school. To support your application please be as specific as you can about your current need. Please note that we are expecting a high number of requests in comparison to devices available and so not all applications will be successful.

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