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Chromebook Lost/Damaged Form

Please full out the information below and include the total cost to repair/replace your device in the envelope provided.

Replacement/repair will not occur until the associated cost has been paid in full.

Today's Date*

Answer Required

Student's full name*

Answer Required

Please note: There will be no refunds once transaction has been completed.

Name of person completing the form*

Answer Required

Select the option*

Answer Required

$20.00 - Lost charger

$50.00 - Broken Chromebook

$200.00 - Lost Chromebook

Confirmation Email

Confirmation Email *

Email Required