Chromebook Replacement Form
*THIS FORM IS FOR LOST, STOLEN, OR EXCESSIVELY DAMAGED DEVICES ONLY*

Please complete the following form to request a Chromebook replacement. Once the submitted form is reviewed, the District will send you an invoice for the amount due.
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Student's First Name *
Student's Last Name *
School Building *
Grade in the Current School Year: *
My child's device was: *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Parent/Guardian Street Address *
City/Town *
Zip Code *
Parent/Guardian Email *
Phone Number *
The Chromebook User Agreement
https://docs.google.com/document/d/1DaaJHt54LQim9lDp4R00M90_wT20rwP6LAWgq56fh7M/edit?usp=sharing
*THIS FORM IS FOR LOST, STOLEN, OR  EXCESSIVELY DAMAGED DEVICES ONLY* *
By acknowledging below, you are accepting responsibility for the cost of the replacement Chromebook for your student. Please be aware; the Commack Union Free School District will send an invoice to the address provided above. *
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