Social Media Usage Time Limit Change Request Form
Request a change to your current social media usage time limit. Please provide the necessary details below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Social Media Platform
*
Please Select
Facebook
Instagram
Twitter/X
TikTok
Snapchat
Other
Current Daily Time Limit (in minutes)
*
Requested New Daily Time Limit (in minutes)
*
Reason for Request
*
Preferred Effective Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Request
Should be Empty: