Device Damage Report Form
Please complete this form and return the iPad to your child's school. The Technology Department will get back to you.

Technology Department 516-918-2332
Director of Instructional Technology & Library Media Services: Ana M. Ritter 516-560-8872
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Email *
Student's First and Last Name: *
Student ID# *
Device type: *
Device Asset Tag# *
Parent/Guardian Name: *
Student's school for the 2020-2021 *
Primary Contact Number: *
Parent Email Address: *
Parent Mailing Address: *
Parent City and Zip Code *
Incident Date:
Incident Location: *
Circumstance/Description of the Incident: *
Has the student had any previous device incidents? *
Questions, comments or concerns?
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