Chromebook Request Form
Please complete this survey if your Vanderburg student is in need of a Chromebook device. If they have already checked out a Chromebook from the school, they will not qualify for a second device. Each student is entitled to borrow one device if they do not already have a computer to use from home.

If you are having technical difficulties with a device, please contact our Site Based Technician, Mr. Floyd at

If you have a second child that needs a device, please fill out this form again with their information.
Email address *
Student Last Name: *
Student First Name: *
Grade: *
Check this box if you are requesting a replacement Chromebook due to technical issues. You will have to return the other Chromebook in order to receive the new one.
Please explain why you need to exchange your Chromebook for a new one? What is not working?
Never submit passwords through Google Forms.
This form was created inside of Clark County School District. Report Abuse