2021-2022 Chromebook Incident Report Form
NOTE: This form collects information for "Insurance Purposes Only." It does NOT alert the school you need a repair. PLEASE contact your school site's librarian for further assistance after you have submitted this form.

Si necesita ayuda para llenar este formulario en español, por favor contacte a Andrea Fernández al (530) 563-8841/afernandezlanda@ttusd.org, o a María Torres al (530) 563-8843/mtorres@ttusd.org

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Email *
STUDENT'S First Name *
STUDENT'S Last Name *
Grade *
School Site *
Type of Chromebook *
Find the Serial Number, it may say Serial Number or SN:
Chromebook Serial Number *
Find the Tahoe Truckee USD Number
Tahoe Truckee USD Number  or Charger number if  your Charger is Broken *
Located on the bottom of the Chromebook
Date the incident happened?   *
Where did this happen?  Example: home, class, bus *
Explain in DETAIL how your Chromebook got damaged, or what isn't working? "In my backpack" IS NOT AN ACCEPTABLE ANSWER. Insurance only covers ACCIDENTAL damage with an EXPLANATION *
Was this an accident *
Problem Category *
Please select category that best describes issue.
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