VLACS K12 Internet & Computer Assistance Application

Parent/Guardian Information

Parent/Guardian Legal First Name

Parent/Guardian Middle Initial

Parent/Guardian Legal Last Name

Parent/Guardian Preferred Name (if different from above)

Parent/Guardian Email Address

Parent/Guardian Phone Number

Parent/Guardian Mailing Address

Town

State (abbr.)

Zip Code

Student Information

Student Legal First Name

Student Middle Initial

Student Legal Last Name

Student Preferred Name if different from above)

Student Date of Birth

Student Email Address

Student Phone Number

The purpose of this assistance is to provide laptops and internet access to New Hampshire-resident full-time VLACS students whose families do not have sufficient financial resources to purchase these technologies. Please note that the availability of this assistance is subject to our current funding levels. As our resources are limited, we may not be able to assist all eligible students immediately. We appreciate your understanding and support as we work diligently to help as many students as possible.

1. Please select for which type of assistance you are applying:

InternetLaptopBoth internet and laptop

2. Please explain why you are applying for this assistance.

Contact Information