CCSD#1 Take Home Device Agreement
Converse 1 – Take-Home Device Agreement

If you meet district requirements - please complete this form to be considered for a take home device if one is available.

This agreement for home use of a district-owned device is between the parent/guardian or student (in the case of an unaccompanied youth situation) and Converse County School District #1 (CCSD#1) for a technology device deemed necessary for educational use. Devices include but are not limited to iPads, computers, and any other assistive technology device deemed appropriate for home use by CCSD#1. Rules and guidelines for home use include the following:
• As all sent-home devices are property of CCSD1, they are to be used appropriately as educational tools.
• Parents/guardians need to be present during the device’s operation to ensure the student’s safety while in use. Internet filters, where appropriate, are installed on devices for home use; however, web searches from home networks always require parent/guardian supervision.
• No food or drink is allowed next to the device.
• Cords or removable storage is to be inserted carefully into the device.
• Devices are never to be left on the floor, on a chair, sofa, etc.
• Stepping on or sitting on the device is prohibited.
• In the event a device requires repair of any kind, it is to be returned to the CCSD#1 Technology Department. At no point is a parent/guardian or student to attempt to repair the device. Please contact the Technology Department for immediate assistance in the event a repair is necessary for any part of the device.
• CCSD#1 is not responsible for any content or harmful information reviewed while outside of the established school district network. CCSD#1 is not responsible for any physical harm done to the student while the device is checked out for out-of-school district use.
• Costs for repairs required, outside of customary wear and tear, to the device will be at the expense of the parent/guardian or, in the event a device is checked out to an unaccompanied youth, the student. Cost may include labor costs, equipment replacement, and parts associated with the repairs.
• Intentional damage to the device will result in the parent/guardian or student being charged for the full replacement of the device.

Devices are due back to CCSD#1 when students are allowed to physically return to school or at the end of the school year.

Sign in to Google to save your progress. Learn more
Email *
What schools are your student(s) in?
I agree to take care of the device as per the agreement. *
Parent Name *
Student Name *
Date *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Converse County School District #1. Report Abuse