Device Hardware Repair Request Form

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It is important that learners have a working device to access instruction. If a device is broken, please complete the information below. After completing this form, please drop off the device at the your child's school Monday - Friday between the hours of 8:00 - 2:30 on regular schools days. A loaner device will be provided until the device is repaired.

*This form and office hours associated with it are strictly for the repair of device hardware issues. For software related issues please email your school's computer technician directly. SES (cwestfall@salisburysd.org), SMS (jlandis@salisburysd.org), and SHS (tsmith@salisburysd.org).

Parent Name *

Parent Phone Number *

Parent email address

Student Name *

Student Grade *

Student ID Number *

Device Asset Tag Number (printed on the sticker on the bottom of the computer or the back of the iPad) *

Detailed description of the issue with the computer or iPad *

Any known accidental damage? (This includes physical damage from liquid spills, falling/dropping, closing lid with something on the keyboard, etc.) *

Yes

If there was accidental damage please describe the damage.

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