STUDENT DEVICE REQUEST FORM
Fillmore Unified Technology Services

The purpose of this form is for parents and/or guardians of students enrolled within one of our schools in the Fillmore Unified School District to be able to request for a device that can be used for distance learning. This request should be made only if no personal devices are available for distance learning. Please be considerate of district resources during this challenging time. Thank you

Please complete the form below. Required fields marked with an asterisk *

Fillmore High School - Student Device Request Form