Student Chromebook Problem Form
This form should be used when a student Chromebook is defective, damaged, or needs repair. A second Chromebook will be issued to a student while the first is evaluated. Receiving a second "loaner" Chromebook does not resolve the student from liability for the first device. The student will be notified by school staff on how to proceed for the first Chromebook.
Please fill out all parts in the Student Section below:
Student's Last Name
Student's First Name
Student ID Number
What school do you attend?
Chromebook Number (This is the barcode number located on the sticker on the back of the Chromebook)
Problem with Chromebook? Mark all that apply. If you need a charger, mark "Other" and state what you need.
Chrome OS Missing or Damaged
Exposure to Liquid
Outer Case Damage
Won't Turn On
Keys won't work
Keys loose or missing
I have insurance
I don't know
I understand that I am responsible for all damages or repairs, unless verified by school staff.
Yes, by clicking yes you are submitting an electronic signature
I would like to pick up a charger or bring my Chromebook in for repair and pick up a loaner Chromebook on the following day (you may only choose Monday to Friday dates). Pick-up will occur in your School Library (either ANHS or GBHS) between 7:15 and 3:30 pm.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of RJUHSD.