CCSD Technology Department - Property Loss Notice 
Please utilize the form to report your Child's device either Lost or Stolen.  Complete this  Google Form in its entirety with the specific information regarding this loss or theft so that we may process the insurance claim.  Once this form is completed, we will be able to issue your student a replacement Chromebook.
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Parent E-mail Address *
Name of Individual Completing This Report (Last Name, First Name) *
Last Name of Student *
First Name of Student *
Building the Student Attends *
Student Grade Level *
Device Type *
If you've indicated "other" device type, please describe in the space below.  
Is the charger for the device also lost/ stolen? *
Date of Loss *
MM
/
DD
/
YYYY
Time of Loss  *
Time
:
Was this reported to the police?  *
Police Station Name
Police Complaint Number 
Location of Loss *
Description of Occurrence  *
Detailed list of all items lost  *
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