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Evergreen Middle School BYOD Request Form: 2016-2017
EMS is a BYOD (bring your own device) school. This means that we encourage students to bring a device with them every day to school.

If your student is in need of a device, please complete the form below. Completion of this form does not guarantee your student(s) will get a device. We will do our very best to accommodate your needs.

Student's Name (Last Name, First Name)
Your answer
Student's ID Number
Your answer
We are requesting a device because....
Jeffco Schools Student Pledge for School-Owned Device Use
By checking off each of the statements below, I agree to the stipulations set forth in the JS Acceptable Use Policy, Jeffco Schools Take Home Policy, and the Student Pledge for Device Use and understand that my behavior could lead to the loss of the privilege to use the device.
Required
Mobile Device Check Out Agreement-Part 1: Terms of Use
TERMS OF USE: Students/parents/guardians must comply with Jeffco Policies and Procedures at all times inside and outside the District. Any failure to comply may result in disciplinary action and the forfeiture of the student's rights of possession of District property and computing resources. All devices and accessories must be returned in good condition to the school prior to the last calendar day of the school year, unless possession is terminated earlier by District officials or upon the student's withdrawal from school. By electronically signing in the space below, I am acknowledging the district's Mobile Device Check Out Agreement: Terms of Use and am agreeing to the stipulations.
Required
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