1:1 Chromebook Damage or Loss Report
This form needs to be completed to report any damage or loss to any school owned Chromebook.
Student Name *
Include student's first and last name
Your answer
Student Grade Level *
Parent Name *
Include first and last name.
Your answer
Parent Email *
Your answer
Chromebook Number
Middle School Example: CBMS_ High School Example: CB_
Enter the Chromebook Number *
Your answer
Date loss or damage occurred. *
Your answer
Time loss or damage occurred. *
Accidental damaged (select all that apply) *
Malicious damage, lost, or stolen (select all that apply)
Submit a detailed statement explaining what happened to the device. *
Your answer
List any other details or related information not included above.
Your answer
The E-Signature below indicates that all information provided on this form is understood, accurate, and true. *
Please type your name to stating that you agree with the above statement.
Your answer
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