Warsaw ADP Enrollment Form - Secured Tech Solutions

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Confirm Email

How many students/devices are you registering? *

Student Name *

First

Last

Student Grade *

STN (Student Testing Number) *

The STN can be found IN ORANGE on your student's powerschool page. Please call 574-371-5049 for assistance if you are unable to locate your STN in PowerSchool. Please do NOT complete this form without the STN.

Student Name #2 *

First

Last

Student Grade #2 *

STN (Student Testing Number) #2 *

Student Name #3 *

First

Last

STN (Student Testing Number) #3 *

Student Name #4 *

First

Last

STN (Student Testing Number) #4 *

STN (Student Testing Number) #5 *

Acknowledgement of Coverage *

I acknowledge that my device is covered from 8/01/2023 (or date of coverage purchase) through 7/31/2024. If my device is damaged before 8/01/2023, or before coverage is purchased, this ADP coverage does not apply.

Payment

Total

$ 0.00

Authorize.Net *

Card Number

Expiration

Security Code

Comment