Student Chromebook Problem Form

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This form should be used when a student Chromebook is defective, damaged, or needs repair. A second Chromebook will be issued to a student while the first is evaluated. Receiving a second "loaner Chromebook does not resolve the student from liability for the first device. The student will be notified by school staff on how to proceed for the first Chromebook.

Please fill out all parts in the Student Section below:

Email *

West Park High School

Email *

Your email

Today's Date *

YYYY

Student email *

Student's Last Name *

Student's First Name *

Student ID Number *

Chromebook Number (This is the barcode number located on the sticker on the back of the Chromebook) *

Problem with Chromebook? Mark all that apply. If you need a charger, mark "Other" and state what you need. *

Defective

Damaged

Broken screen

Dark screen

Chrome OS Missing or Damaged

Exposure to Liquid

Outer Case Damage

Won't Charge

Won't Turn On

Keys won't work

Keys loose or missing

Other:

Required

I have insurance *

Yes

I don't know

I understand that I am responsible for all damages or repairs, unless verified by school staff. *

Yes, by clicking yes you are submitting an electronic signature

Submit

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