Green HS Chromebook Service Request

GLSD Chromebook Repair Ticket

2025-2026
Name:*

First NameLast Name
Grade Level:*
Chromebook / AC Adapter Number:*
If Faculty/Staff Device, please enter S/N of device.
Problem Category:*

Chrome OS Missing / DamagedBroken ScreenKeyboard not workingBroken / Missing KeysGlide Pad not workingPower Issue (won't turn on)Exposed to LiquidNetwork / WiFiPower Cord missing / damagedProtective Case missing / damagedChromebook (general)EmailOther
Please describe how the damage / issue happened.
STAFF NOTES:

(The following items will be completed by the library and/or technology staff.)

____ Technical Issue _________ Abuse / Neglect_______ _____ Accidental Damage

____ Normal Wear_______ ____ Other _________________________________
Cost of Repair:
For insured students:
Claim Number (i.e., 1, 2, 3...)
Repair Description:
Should be Empty:

GLSD Chromebook Repair Ticket