Warsaw ADP Enrollment Form - Secured Tech Solutions

Open Enrollment Closes on September 9, 2024 at 11:59 PM EST

Hours

Minutes

- Step 1 of 4

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Confirm Email

How many students/devices are you registering? *

Student One

Student Name *

First

Last

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 Grade *

Student #2---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Student #2

Student Name #2 *

First

Last

Student Grade #2 *

STN (Student Testing Number) #2 *

Student #3---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Student 3

Student Name #3 *

First

Last

Student Grade #3 *

STN (Student Testing Number) #3 *

Student #4---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Layout

Student Name #4 *

First

Last

Student Grade #4 *

STN (Student Testing Number) #4 *

Student #5---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Layout

Student Name #5 *

First

Last

Student Grade #5 *

STN (Student Testing Number) #5 *

Student #6---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Layout

Student Name #6 *

First

Last

Student Grade #6 *

STN (Student Testing Number) #6 *

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Acknowledgement of Coverage *

I acknowledge that my device is covered from date of coverage purchase through 7/31/2025. If my device is damaged before coverage is purchased, this ADP coverage does not apply.

Payment

Authorize.Net *

Card Number

Expiration

Security Code

Total

$0.00

Message