Teacher Application Form

Household Contact Information

First name*

Last name*

Email*

Phone number*

Street address

City

State/Region

Postal Code

School Information

K-12 School or College Name*

Grade Level Taught

Plan and Equipment Information

Select Your Desired Plan

Select Internet 50

Select Internet 100

Installation*

Free Installation

Acknowledgements

I acknowledge that I meet the household eligibility requirements to the best of my knowledge.*

I acknowledge that if I should not choose to become a customer with Astrea, the 90 days of free service will be terminated upon completion of the 90 day service period. I am responsible to return all Astrea equipment. If equipment is damaged in any way, I am responsible for any associated fees or costs to replace or repair the equiment.*