Chromebook Violation Form

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Email *

Date of Violation *

YYYY

Assigning Teacher's Name *

Student's Last Name *

Student's First Name *

Grade *

Required

Violation (check all that apply) *

Cyberbullying/Inappropriate emails/threats

Destructive Behavior

Food/drink near device

Left device unattended

Marking/hitting the screen or cover

Moving with open lid

Touching someone else's device

Use not directed by teacher/playing games or music

Dropping device

Off Task

Other:

Required

Description of the violation *

Consequences for Mishandling of Chromebooks

Warning

Silent Lunch

Loss of Privilege (Next Full Day)

Loss of Privilege + Office Referral to Administration for Disobedience

Administrator Discretion

Other:

These consequences only relate to loss of Chromebook privileges. Additional disciplinary action may be taken if deemed necessary by the administrators.

Student Signature: _____________________________________

Parent Signature: ______________________________________

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