Full Name
Student ID number
Email
Contact number *
Which campus do you study at?
If answered other above, please specify where you study at
Have you applied for the Learner Support Fund?
Do you have internet access and wifi at home?
What are the reasons you require help to access the internet? *
Signature (Please type in your full name) *
Date signed *

Request form

Please fill out the form to request a dongle loan.