Staff Exit Form
Complete this form to setup a time to check-out of the technology department before leaving for the summer.
First Name *
Last Name *
Building *
Last date you will be in the district *
MM
/
DD
/
YYYY
Current Email Address *
This is your school email address
New Contact information *
Email address or phone number. This is only used if we need additional information. It won't be shared.
Date you will turn in your technology to the technology department *
MM
/
DD
/
YYYY
Time of day you will turn in your technology to the technology department *
PIN or Password
If you have a PIN or Password on your technology device, enter it below. (iPad-Computer)
Questions or Comments
If you have questions or comments, enter them in the space below.
Summer School - Other
If you are working summer school or working past July 1st, you will be issued a temp laptop to use for those sessions. Please, indicate if you are working summer school/other this year.
Submit
Never submit passwords through Google Forms.
This form was created inside of Perry Community School District. Report Abuse