PMVS Internet Reimbursement Form

Internet reimbursement is only for students enrolled in PMVS.

Full time virtual students may request Internet Service Provider fee reimbursement of up to $40.00/month during the regular academic year (September through May). Reimbursements will begin after the student has successfully participated in the full time program for one full month and will be made for three month intervals (September-November, December-February, March-May). Penn Manor School District may terminate Internet Service reimbursement at its sole discretion. Forms required for Internet reimbursement requests will be provided at the on-site student orientations held at the beginning of each new school year.
Student Name*
First Last
Student ID*
Parent/Guardian Name*
First Last
Parent/Guardian Relationship to Student*
Grade*
Additional Students
Please provide student name, ID number, and grade level for any additional students in the residence.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent Phone Number*
Parent Email*
Service Months*
Service Bills*
Drop files here or

Max. file size: 24 MB.
Please upload your entire bill for each of the 3 months.
Comments
This field is for validation purposes and should be left unchanged.