Appliance Request Form

Personal Appliance Request Form

Please complete the following form to request permission for use of a personal appliance in your classroom or workspace for educational purposes. This request will be reviewed and approved/denied by your Principal.

Please pick your location from the drop down: 

First Name: 

Last Name: 

Room #:    


What type of appliance are you requesting permission for? (Please be specific) 

What is the need for this appliance? (Please be specific) 


Security Measure