Form

City Station Student Information
Student Name *

First Name Last Name
How Would You Like To Be Contact? *

E-Mail Phone Call Text Message
Student E-mail *
Cell Number

- Area Code Phone Number
Building *
Apartment/Suite# *
Bedspace *
Upload a file or screen shot
Computer Type *

Apple PC Other
Computer Information
Computer Type (If Other)
Operating Systems *

Windows 8 Windows 7 Windows XP Mac OSX Other
Operating Systems (If Other)
What is the problem?
Select Your WIFI/Internet Issues *

Can't Connect Loading Slow Kicked Off Can't Game No Idea Ethernet Cable WIFI Settings
Please Explain Your WIFI/Internet Issue *
Enter the message as it's shown *
Should be Empty: