Student Internet Accessibility Request Form

The Benton School District has been provided a limited supply of internet hotspots for the sole use of students. To get the devices to those most in need, we are seeking information. Please note that filling out this form does not guarantee one will be available as the number of devices is limited.

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* 1. Your Name and Physical Address

Your Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. How many children living with you attend Benton Public Schools?

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* 3. What are the names of the children living with you who attend Benton Public Schools?

Child's Name

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* 4. Please select any of the following that applies to your child/children:

Student is learning virtually due to a COVID-19 related health situation and does not have access by other means to connectivity for online/blended learning materials and resources.

Student is economically disadvantaged and requires additional assistance acquiring connectivity for online/blended learning materials and resources.

Student is experiencing homelessness and requires additional assistance acquiring connectivity for online/blended learning materials and resources.

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* 5. Do you have reliable transportation and can access the internet for your child/children at one of these locations?

Hot Spot access points have been distributed to local churches and Big Red Stores. Students that need internet access can go to these locations with their school-issued device, and automatically be connected to the hot spot.

620 Military Rd, 820 Edison Ave., 2908 Congo Rd., 1219 W. South St., 109 East Woodson Lateral Rd. (Hensley), 4720 US-67.

First Baptist Church Benton, First Church of the Nazarene, Ten Mile Missionary Baptist Church, Holland Chapel, First Presbyterian, Trinity Baptist Church, Salem Methodist, Elect Temple, Gateway, Highland Heights.

Yes

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* 6. Which cellular service provider has good service at your residence (Check all that apply)?

AT&T

T-Mobile

Verizon

Unsure

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* 7. I acknowledge that the use of the internet device is only for school-related purposes only. Any usage must conform with District policies regarding computer use is subject to review. If a device is available, the terms for usage can be found here. The District Internet Use Policy can be found here.

Acknowledge

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* 8. Do your children attend school onsite (at the school) or online?

Onsite (at the school)

Online