Request for Assistance with Internet Access - For Families Not Eligible for Internet Essentials

Please complete this form if you have recently attempted to apply for the Comcast Internet Essentials Program and have been denied. An SDoL staff member will reach out to you to assist you.

Comcast Internet Essentials Application Denial*

Please upload a screen shot that shows that you applied for and were denied access to the Comcast Internet Essentials Program.

Drag and drop files here or

Guardian Last Name*

Please indicate the last name of the guardian who is applying for internet for his/her home on behalf of SDoL students residing there.

Guardian First Name*

Please indicate the first name of the guardian who is applying for internet for his/her home on behalf of SDoL students residing there.

Street Address*

Please indicate the street address where the internet service will be provided. NOTE: This must match the home address of all students connected to this application.

Apt/Unit #

Please indicate the Apt/Unit #, if applicable, where the internet service will be provided.

City*

Phone Number*

Please provide a valid, current phone number that SDoL and Comcast staff can use to follow up with you.

Email Address

If you have one, please provide a valid, current email address that SDoL staff can use to follow up with you.

What kind of internet access do you need?

In order for us to provide internet access to your house, we need to know if your house is already wired for cable internet access. Please review the statements below and indicate the statement that best describes your situation.

My house has cable access.

My house does not have cable access.

I don't know if my house has cable access or not.

How many SDoL students reside in this household?*

Please provide us the total number of SDoL students who reside in this household. Note that the home address on this application should match the home address that is on file for this student at the district.

Select

SDoL Student #1 - ID Number*

Please provide the SDoL Student ID Number for the first SDoL student who resides at your house.

SDoL Student #1 - Last Name*

Please provide the last name of the first SDoL student who resides at your house.

SDoL Student #1 - First Name*

Please provide the first name of the first SDoL student who resides at your house.

SDoL Student #1 - Building of Attendance*

Please indicate the building of attendance of the first SDoL student who resides at your house.

Select

SDoL Student #2 - ID Number

Please provide the SDoL Student ID Number for the second SDoL student who resides at your house. If you only have one SDoL student who resides at your house, scroll to the bottom and click "Submit."

SDoL Student #2 - Last Name

Please provide the last name of the second SDoL student who resides at your house.

SDoL Student #2 - First Name

Please provide the first name of the second SDoL student who resides at your house.

SDoL Student #2 - Building of Attendance

Please indicate the building of attendance of the second SDoL student who resides at your house.

Select

SDoL Student #3 - ID Number

Please provide the SDoL Student ID Number for the third SDoL student who resides at your house. If you only have two SDoL students who reside at your house, scroll to the bottom and click "Submit."

SDoL Student #3 - Last Name

Please provide the last name of the third SDoL student who resides at your house.

SDoL Student #3 - First Name

Please provide the first name of the third SDoL student who resides at your house.

SDoL Student #3 - Building of Attendance

Please indicate the building of attendance of the third SDoL student who resides at your house.

Select

SDoL Student #4 - ID Number

Please provide the SDoL Student ID Number for the fourth SDoL student who resides at your house. If you only have three SDoL students who reside at your house, scroll to the bottom and click "Submit."

SDoL Student #4 - Last Name

Please provide the last name of the fourth SDoL student who resides at your house.

SDoL Student #4 - First Name

Please provide the first name of the fourth SDoL student who resides at your house.

SDoL Student #4 - Building of Attendance

Please indicate the building of attendance of the fourth SDoL student who resides at your house.

Select

SDoL Student #5 - ID Number

Please provide the SDoL Student ID Number for the fifth SDoL student who resides at your house. If you only have four SDoL students who reside at your house, scroll to the bottom and click "Submit."

SDoL Student #5 - Last Name

Please provide the last name of the fifth SDoL student who resides at your house.

SDoL Student #5 - First Name

Please provide the first name of the fifth SDoL student who resides at your house.

SDoL Student #5 - Building of Attendance

Please indicate the building of attendance of the fifth SDoL student who resides at your house.

Select

SDoL Student #6 - ID Number

Please provide the SDoL Student ID Number for the sixth SDoL student who resides at your house. If you only have five SDoL students who reside at your house, scroll to the bottom and click "Submit."

SDoL Student #6 - Last Name

Please provide the last name of the sixth SDoL student who resides at your house.

SDoL Student #6 - First Name

Please provide the first name of the sixth SDoL student who resides at your house.

SDoL Student #6 - Building of Attendance

Please indicate the building of attendance of the sixth SDoL student who resides at your house.

Select

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