Student Surplus Chromebook Request Form

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Boone County Board Policy 04.8 – Disposal of School Property:

If the District receives a written determination that surplus technology does not meet Kentucky Education Technology System standards, it may choose to distribute the refurbished surplus property to eligible low-income students.

First priority shall be given to eligible students in the free or reduced lunch program, and they or their parent/guardian must request the property in writing.

Per the above policy, parents/guardians must initiate the request. Completion of this form begins that process.

Email *

Student First Name *

Student Last Name *

Student Date of Birth *

YYYY

Student Number on IC Report Card *

Student Address (Number, Street Name, Apt #) *

City *

State *

Zip Code *

School *

Grade Level *

Guardian/Parent First Name *

Guardian/Parent Last Name *

Guardian/Parent Address *

City *

State *

Zip Code *

Home Phone *

Parent Email Address *

Terms and Conditions *

By checking this box, I verify and attest that the information submitted on this form is correct and I am in agreement with the Terms and Conditions of the donation.

Required

A copy of your responses will be emailed to the address you provided.

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