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.
Student Last Name:
Student First Name:
Self-Contained Primary (K-2) Autism Program
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.
I need a different Chromebook and I will bring back the one I have now.
Please explain why you need to exchange your Chromebook for a new one? What is not working?
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This form was created inside of Clark County School District.