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Lakeland CoAI Device DAMAGE Form
“Break and fix” tech support, such as a cracked screen, or headphone jack that does not work, should be reported by filling out this form.
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* Indicates required question
Which school do(es) you/your child attend?
*
Choose
Benjamin Franklin ES
George Washington ES
Lincoln-Titus ES
Thomas Jefferson ES
Van Cortlandtville ES
Lakeland Copper Beech MS
Lakeland HS
Walter Panas HS
Student's LAST Name
*
Your answer
Student's FIRST Name
*
Your answer
Student's Grade
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Choose
Gr. K
Gr. 1
Gr. 2
Gr. 3
Gr. 4
Gr. 5
Gr. 6
Gr. 7
Gr. 8
Gr. 9
Gr. 10
Gr. 11
Gr. 12
Option 14
Teacher's LAST Name
Your answer
Contact e-mail address
*
Your answer
Contact phone number
*
Your answer
Details
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Please be as detailed as possible.
Your answer
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