District Chromebook/iPad Request Form
Please complete the following form to sign out a district device. The device will be prepared and signed out to the student for pickup at the school's main office during the next school day.

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Email *
Parent/Guardian Name *
Student Name *
School *
DISTRICT OWNED DEVICE LOAN AGREEMENT
I am being loaned a DISTRICT OWNED DEVICE for academic and job related purposes. It is my responsibility to care for the equipment and ensure it is maintained in a safe environment. If the device, power cord or equipment is lost, stolen or damaged while in my possession, it is my responsibility to immediately report it to the technology department for replacement or repair.
Also, Pitman Public Schools is not responsible for any computer or electronic viruses that may be transferred from any data storage medium and I agree to use my best effort to assure the district property is not damaged or rendered inoperable by any such electronic virus while in my possession.

I also acknowledge that I will not attempt to circumvent any security measures put on the device, download any software, or install any hardware that is not approved by Pitman Public Schools. For a list of approved apps, software, and hardware, please refer to the school’s website.

Additionally, I agree the device is owned by Pitman Public Schools, and it is my responsibility to protect and safeguard the district property and to return the device in good-working usable condition.  In the event that the device is damaged, it will be the family's obligation to pay for all repairs, either through the Pitman Insurance Plan or full replacement cost of repair/device. All information on the Insurance Plan and replacement costs can be found on the district website.

By agreeing below, I acknowledge and agree to all of the following responsibilities for having a district device.
- It is the student’s responsibility to charge their device daily to have a full charge for school.
- Students will keep the devices clean and refrain from eating and drinking at the device.
- The devices will be used only for school-related purposes.
- Students will keep their devices clean and not attach any stickers that could potentially damage the device.
-Students will keep their devices safe and secure at all times

Students and families also acknowledge and agree to the terms of use as spelled out in the Board of Education Policies:
2360- Use of Technology
2361- Acceptable use of Computer Network/Computers and resources
2361.1- Internet Use
3283- Electronic Communication Between Teacher Staff and Students
3321- Acceptable Use of Computer Network/Computers and resources/teaching Staff members
4283- Electronic Communications between Support Staff Members and Students
4321- Acceptable Use of Computer Network/Computers and Resource Support Staff Members.

By clicking agree, upon receiving your device, you are agreeing to the terms set forth in the Pitman Public Schools District Owned Device Agreement. *
Pitman Insurance Plan (PIP) - Optional Opt-In
Repairing Chromebooks and iPads represent a significant cost to the district. Repair and replacement costs for the district Chromebooks are as follows:

Families will be given 2 options for the Pitman Insurance Plan (PIP) and have 45 days upon receipt of their device to enroll in a plan. If a family does not respond by the deadline, they will be enrolled in Option 2.

Option 1: Insurance Plan
The first option is to pay a yearly premium insurance fee for the repair of the Chromebook.
$35 - Non-Free and Reduced Lunch Families
$20 - Reduced Lunch Families
$10 -  Free Lunch Families
This insurance plan would cover 2 claims a year. Claims constitute repairs to the device or replacements devices and chargers. After the 2 incidentals have been used up, the family will be billed the cost of the replacement part and/or device.

Option 2: Full Replacement Cost Plan
In this option, the family would not enroll into the Pitman Insurance Plan and be responsible for the full repair and replacement costs. The following is a list of repair/replacement costs. If a repair is needed that is not found on this list, the family will be contacted with a breakdown of cost.

Chromebooks
Screen Replacement
$90
Keyboard Replacement
$50
Charger Replacement
$40
Frame / Body Replacement
$60
Device Replacement
$250

iPads:
Screen Replacement
$150
Case
$30
Device Replacement
$299

This & more informationcan be found via the Pitman Public Schools Family Technology Handbook 2020-2021.
Link: https://docs.google.com/document/d/1TiDTfl8qIa7BMjhnedfbyBlKXwtrvb9WT46WFEz0Jss/edit?usp=sharing

Would you like to be contacted regarding the optional Pitman Insurance Plan (PIP) enrollment? *
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