Closed School Student Form Closed School Student Form Emily Cooperative Telephone Company and Crosslake Communications will be providing FREE entry level internet service for two (2) months to families with students in the ECTC or Crosslake Communications serving areas that currently do not have services for student online learning. This form is for parents and guardians of students (college or otherwise) whose school or university has shut down due to coronavirus (COVID-19). This service is for families with students that have not had previous internet service with us. Once approved, this form will allow for two (2) months of FREE entry level internet service. Customer Information Parent or Guardian First Name * Parent or Guardian Last Name * Last 4 of SSN (for account verification): * E-911 Street Address * City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip * Different Billing Address? * Yes No Billing Street Address Billing City Billing State Option 1 Billing Zip Phone * Email * Student Information Student #1 Name * Student # 2 Name Student # 3 Name Student # 4 Name 1. Name of closed school your student(s) attends in the ECTC and Crosslake Communications Serving area: * 2. Name of closed school your student(s) attends in the ECTC and Crosslake Communications Serving area: 3. Name of closed school your student(s) attends in the ECTC and Crosslake Communications Serving area: 4. Name of closed school your student(s) attends in the ECTC and Crosslake Communications Serving area: What is the current known date school will re-open? * Name of Closed University your student(s) attend: Please upload a copy of the students' current student ID card or recent report card with school name. * Drop a file here or click to upload Choose File Maximum upload size: 516MB By typing and signing your name below, you agree this is an electronic signature. You also agree that the student(s) name you submit does live in your household. Name * Date * reCAPTCHA Submit