Device Request

This Device Request Form should be used by participating MLTI schools (Cohorts 3 and 4) to request an MLTI device from the Enrollment Pool to serve a student or staff member who is new to your school. The school will contact the MLTI Project Office through this online request form, and MLTI will determine whether the school should obtain the device from an Enrollment Pool school in the area, or whether MLTI will ship the device from the DOE Enrollment Pool in Augusta.

If you have any questions, please send an email to the MLTI Project Office.

Please complete the form and hit submit. You will receive an email confirmation of your request. (*Indicates a required field.)

Requestor Information:

First Name :

Last Name:

Email:

Phone:

Date: (mm/dd/yyyy)

Platform:

School*

If your school is not in the list, please select Other and put your school name & school code in the following text box:

Number of Devices Needed (Please be specific when indicating staff role.)

Each field requires an answer, so please use a 0 if the field does NOT apply to you.

Student K-6 Devices

Staff K-6 Devices

Role of K-6 Staff

Student 7-8 Devices

Staff 7-8 Devices

Role of 7-8 Staff

Student 9-12 Devices

Staff 9-12 Devices

Role of 9-12 Staff

**School Student Moved From

Enrollment Information. Please enter the total enrollment for your school's 7th & 8th grade students or 9th - 12th grade students, whichever is applicable to this request.

Each field requires an answer, so please use a 0 if the field does NOT apply to you.

Grades K-6 Students

Grades 7 & 8 Students

Grades 9-12 Students

Notes (i.e., special arrangements are being made to transport the device, etc.)

Once you have completed this request form, please hit submit. Your request will immediately be emailed to the MLTI Project Office.

Maine.gov