BISD Chromebook - Accidental Insurance Assistance Form (2023-2024)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Bainbridge Island School District recognizes that not every family has the ability to pay for accidental insurance for BISD Chromebooks. Parents and guardians who would like to insure their student's school device, but are facing financial challenges, may submit a request to waive the insurance fee for the current school year.

Using the form below, please submit information for EACH student in your family currently attending a school in the district. Please note that only school devices issued to students in GRADES 5 and HIGHER qualify for accidental device insurance.

We will review your request and inform you of our decision within two to four weeks. Families who are approved for insurance relief will receive insurance coverage retroactive to the start of the school year.

IMPORTANT: This form only supports 5 students per submission. If your family has more than 5 students in grades 5 through 12, please submit the first 5 students and then repeat the process for any additional students.

**ALL INFORMATION SUBMITTED WILL BE KEPT CONFIDENTIAL**

Parent or Guardians First Name *

Parent or Guardians Last Name *

If your family qualified for the Free and Reduced school meals in the 2022-2023 school year, OR if you predict you will qualify for Free and Reduced school meals in the 2023-2024 school year, do you give permission for BISD to waive this accidental insurance fee for your student's school Chromebooks? *

Yes, I give permission for BISD to waive this insurance fee.

No, I do not give permission for BISD to waive this insurance fee.

Not applicable. We are not participating in the Free and Reduced school meal program.

Please choose the option that best explains why you are seeking insurance relief. The information you submit will be kept CONFIDENTIAL. *

Long-term financial hardship

Short-term financial hardship

Do not have access to a credit card

Other:

Clear form

Never submit passwords through Google Forms.

This form was created inside of Bainbridge Island School District. Report Abuse

Forms