If you do receive a Chromebook, you will be responsible for this equipment until the return date. To AVOID ANY FINE, we ask to please keep your assigned Chromebook and charger in a safe place as you will be responsible if the Chromebook is damaged or lost. If you agree, please Submit after completing this form. Students can pick up Chromebooks at walk through registration.
Student's Last Name
Student's First Name
Grade level for 2020-2021
Primary Phone Number
Reliable internet Access
Yes I have internet access at home
No I do not have internet access at home
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This form was created inside of Mt. Diablo Unified School District.