JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Request for School Chromebook Grades 7-12
Students may request to sign-out a school issued Chromebook for the 2025-2026 School year
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student Phone number
*
Your answer
Student Email Address
*
Your answer
Grade Level
*
Choose
K
1
2
3
4
5
6
7
8
9
10
11
12
Your laptop is an important learning tool, and its use is a privilege. It is to be used for educational purposes. You must be willing to accept the following responsibilities:
*
Student will abide by and understands that digital citizenship includes the responsible use of social media and other web sites and general adherence to district policies and procedures.
Student understands that District filters are in place while on campus and connected to the District Network, limiting access to materials that may be considered harmful to children.
When using the laptop at school, at home, and/or anywhere else, the student will follow the policies of the Jefferson-Morgan School District, especially the Acceptable Use Policy, and will abide by all local, state, and federal laws and statutes.
Student will treat the laptop with care by NOT dropping it, getting it wet, leaving it outdoors or in an unsafe area, or submitting the laptop to extreme conditions/temperatures.
Student will not lend the laptop to anyone, not even friends or family; it will be kept in a secure place at all times.
Student will bring the laptop and charger to school each day. The laptop will be charged and ready for use.
Student will agree that any electronic communications should be used for legitimate, appropriate, and responsible reasons.
Student will keep all passwords, personal identifications, and accounts secure and will not share or provide the information to others.
Student will not attempt to repair the laptop and will follow District procedures requesting assistance.
Student will return the laptop whenever requested and specifically upon withdrawal or departure from the district.
If a student transfers school districts, they must return all district issued technology
Required
The student understands that they must bring their Chromebook to school daily and it must be charged.
*
Yes
No (Chromebook will not be issued)
Do you need to sign out a T-Mobile/AT&T Hot Spot for internet access at home? *Priority will be given to students without internet home access
*
Yes
No
Any Damage to the following equipment will be charged to the student. BY checking the box you understand the cost to replace the school issued technology
*
Chromebook ($250)- Depends on which Chromebook you are assigned (covered if you purchase the insurance)
Chromebook Charger ($30)
Case ($25)
Internet Hot Spot ($100)- If requesting one
Required
We understand that if our child transfers to another school, they must return the devices they signed out before records will be transferred by the school
*
Yes
No, chromebook will not be issued
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Jefferson-Morgan School District.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
