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Chromebook Request/Acceptance Form 2023-2024
Please complete this form (for each student) to request and accept the conditions for use of a Medford Public School Chromebook.
Form must be completed by caregiver or student (if over 18 years old).
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* Indicates required question
Student Last Name
*
Your answer
Student First Name
*
Your answer
Caregiver Last Name
*
Your answer
Caregiver First Name
*
Your answer
School Name(s)
*
Medford High School
Medford Vocational Technical High School
Curtis Tufts
Andrews Middle School
McGlynn Middle School
Grade
*
6
7
8
9
10
11
12
Other:
I have read and accept the conditions of the
Chromebook Acceptance Form
*
Yes
No
I have reviewed the
Chromebook Care and Use Guide
*
Yes
No
I have reviewed and accept the
Responsible Use Policy
for the use of the MPS Chromebook.
*
Yes
No
Contact Information: Address and Phone Number
*
Your answer
Date
*
MM
/
DD
/
YYYY
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