Chromebook Request Form

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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

Email *

Name of parent/guardian *

Phone number of parent/guardian *

Who is the Homeroom Teacher *

Student Name *

Enter the full name of the student who needs a replacement Chromebook

Student ID *

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

Required

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

Questions and comments

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