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Chromebook Replacement Form 23-24
Parents/guardians should fill out this form when a student indicates that they:
1. No longer have their assigned Chromebook because it is lost/ stolen
2. If a student has a broken Chromebook
The school will confirm the provided information and parents/guardians will need to come to the school to sign out the new technology.
Please Be Sure to Read the Chromebook Acceptable Use Policy
https://docs.google.com/document/d/1M6RjJNEconSEk8FwJdX9bvLYVVqeh-0b56jFj8_dxCU/edit?usp=sharing
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* Indicates required question
Email
*
Your answer
Name of Parent/Guardian
*
Your answer
Phone Number of Parent/Guardian
*
Your answer
Homeroom Number/Teacher
*
Your answer
Student Name
*
Your answer
Student ID (if known)
Your answer
What is the reason for the replacement request
Broken Charger ONLY
Broken Chromebook
Lost Chromebook (the lost chromebook will be deactivated and become unusable through the replacement process)
Stolen Chromebook (the stolen chromebook will be deactivated and become unusable through the replacement process)
Locked Chromebook
Clear selection
Current Chromebook Serial Number*
What is the serial number / service tag for the current Chromebook if the student has it with them ? If no Chromebook is available just write N/A
*
Your answer
Questions and comments
Your answer
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