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Imhotep Technology Support & Materials Request

Please complete the form below. Required fields marked with an asterisk *

Student First Name*

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Student Last Name*

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Student Email Address

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If you are a parent/guardian completing this form on behalf of your student, please enter your full name below.

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Parent/Guardian Email Address

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Parent/Guardian Mobile Phone

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Please select the type of support needed*

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Describe the issue that you are having. Please be as specific as you can. (i.e. If you need to pick up materials, list the classes your student is currently enrolled in.)*

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(Optional) If you are able, please attached a screen capture of the error message or concern

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Confirmation Email

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