JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Student Technology Device Issue Report
Please complete the form below with as much detail as possible. The device will be picked up from homeroom.
*This process is under review and will change based upon user feedback.
* Indicates required question
Email
*
Record my email address with my response
Student First Name:
*
Your answer
Student Last Name:
*
Your answer
School:
*
BCS Elementary School
BCS Middle School
Homeroom Room #:
*
Your answer
Homeroom Teacher:
*
Your answer
Device:
*
iPad
Chromebook
Device Issue:
*
Device won't turn on
Device won't hold a charge
Device won't connect to WiFi
Device won't connect to apps
Device is Damaged / Lost (Student responsible for repair/replacement fee)
Other:
Required
Is a loaner needed?
*
Choose
Yes
No
Additional Details
Your answer
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Berlin Borough School District.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
