Delton Kellogg Device Repair Request
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Student Name: *
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Student Email Address: *
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Student Grade: *
Device Barcode/Asset Tag: (found on back of device) *
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Building: *
Type of Damage: *
More details:
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Requester First Name: *
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Requester Last Name: *
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Requester Phone Number: *
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Requester Email Address:
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Best Method to Contact: *
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