Chromebook Repair Request
This form is only to be used by Parent/Guardians of students from 3rd-8th grade.

***** THIS IS NOT FOR STUDENT USE *****
Parent/Guardian Name *
Parent/Guardian Contact Number *
Parent/Guardian Email *
Student First/Last Name *
Student Grade *
Student Homeroom Teacher *
Please describe the damage below. Please be as detailed as possible. How did the damage occur? What time/date did the damage occur? *
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