Keys for K-12 Application

Thank you for your interest in the Keys for K-12 program. Please complete this online form and click Submit when you are done. After submitting application, please print out and fax signature page within 60 days.

Student's first name
Student's middle name (if any)
Student's last name
Desired user name for Sero email
Student's date of birth
Student's home address
Student's home address (line 2, if any)
Student's city
Student's state
Student's zip code
Student's home phone number
Student's home email address (if any)
Student's current screen reader name and version (if any)
Student's PC details: manufacturer, model, and operating system (must be at least Windows XP)
Parent or guardian's first name
Parent or guardian's last name

The parent or guardian's home address is the same as the student's home address.

Parent or guardian's home address
Parent or guardian's home address (line 2, if any)
Parent or guardian's city
Parent or guardian's state
Parent or guardian's zip code
Parent or guardian's preferred contact phone number
Parent or guardian's home email address (if any)
School's name
School's address
School's address (line 2, if any)
School's city
School's state
School's zip code
Student's current grade level
Itinerant instructor's first name
Itinerant instructor's last name
Itinerant instructor's email address (if any)
Authorizing official's first name
Authorizing official's last name
Authorizing official's position
Authorizing official's preferred contact phone number
Authorizing official's email address (if any)
Authorizing official's fax number (if any)
Email address for future Serotek communications