Mother Lode Chromebook Check-Out Request
Chromebooks can be picked up on Tuesday April 14, between 11 am and 1 pm. By signing for a chromebook, you are agreeing to return it to the District upon the re-opening of school.
Student First Name *
Your answer
Student Last Name *
Your answer
Student Grade *
Teacher Name *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number - (include best time of day to call) *
Your answer
Parent/Guardian Accepts Responsibility For Device and Appropriate Use *
Due to hardship, I need a Chromebook but cannot pick-up. *
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