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Student Technology Request Form
Complete this form if you are in need of technology items. You must be a current NW-SCC student or employee to request technology items.
Note: Please be aware that you will need to show your driver’s license or state-issued ID upon pickup of requested items.
I am (select one):
(Required)
a Student
an Instructor
a Staff Member
Student / Employee Number (A Number)
(Required)
First Name
(Required)
Last Name
(Required)
Cell Phone
(Required)
Additional Phone
Email
(Required)
Preferred Contact Method
(Required)
Email
Phone (cell)
Phone (additional)
Physical Address
City
State
Zip
Please list the courses you are currently enrolled in.
(Required)
Please select any technology items needed.
(Required)
Laptop
Choose pickup location for technology items requested.
(Required)
Muscle Shoals Campus Library
Phil Campbell Campus Library
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