Custom Form Request Custom Form Request Submitter The purpose of this form is to request a new custom electronic form to be created and added to your school's app and/or website. Please note that each new form request will be billed to your school at the rate of $100 per request. Any future updates to the form are covered by your monthly electronic form service at no additional charge. School Name * First Name * Last Name * Position / Title * Email Address * New Form Information Title of Form * Short Description of Form Link to Reference / Model Form Link to an existing form that you'd like to use as a model. Scanned Paper Form Drop a file here or click to upload Choose File Maximum upload size: 516MB Notification Email(s) * Notifications will be sent to the email(s) when the form is submitted. Separate multiple emails by a comma. Deadline for Submission Enter Date and time. Payment Options * No Payment Required Paypal Stripe Authorize.Net Cash Check Charge School Account OtherOther Enable Digital Signature? * Yes No App Button Are you adding the form to an existing App button? * Yes No Name of App Button * Maximum 30 characters Terms & Conditions Amount to be Billed Payment terms & conditions * By signing this agreement, I acknowledge that I am an authorized administrator, teacher, staff member or other employee of the school or organization listed above with the proper authority or appropriate approval from the proper authority to submit this request on behalf of said school or organization. Signature Clear If you are human, leave this field blank.