Student Laptop Request Form

Student Laptop Request Form

Use this form to request issuance, replacement, or repair of a school-owned laptop for instructional purposes. Submission of this request constitutes a certification that the information provided is true and correct, and that the applicant accepts the terms, responsibilities, and financial obligations set forth in this document.

Student Information

Parent / Guardian Information (if Student is a Minor)

Student is under 18 and parent/guardian consent is required

Device Request Details

Request type (select all that apply):
New loan/issuance    Replacement for damaged device    Repair of existing device    Extended loan period

Intended primary use:
Remote / distance learning    In-class instruction    Extracurricular / club work    Assistive technology / accommodation

Requested loan period from to .

Financial Responsibility & Fees

The applicant (or parent/guardian if student is a minor) is financially responsible for loss, theft, or damage in accordance with the schedule of charges established by the institution. Replacement or repair costs may include parts, labor, and administrative processing fees. Fees may be withheld from student accounts where permitted by policy.

I elect to enroll in the optional device protection plan (if available). Enrollment may limit out-of-pocket costs for accidental damage; it does not cover intentional damage or loss due to gross negligence.

Payment method for any required fees:
Charge to school account    Personal payment    Institutional fund / scholarship

Technology Use, Care, and Liability

The device remains the property of the institution. The recipient shall:

1. Use the device in accordance with institutional acceptable use policies and applicable laws;
2. Keep the device secure and return it in good working condition at the end of the loan period;
3. Not remove serial numbers, asset tags, or tamper with device management software;
4. Backup personal data prior to submission for repair; the institution is not responsible for personal data loss;
5. Be responsible for repair or replacement costs arising from loss, theft, or damage beyond normal wear and tear.

The institution reserves the right to remotely manage, update, inspect, or disable the device as necessary for security, software maintenance, and inventory control. Any attempt to bypass security controls or device management software is a violation of policy and may result in disciplinary action.

I acknowledge receipt of the institution's device care and acceptable use policies and accept financial responsibility as described above.

I consent to remote management and inventory tracking of the device for security and administrative purposes.

Data Privacy & Security

The applicant understands and agrees that the institution is not responsible for personal or sensitive data stored on the device. The institution may, at return or retrieval, remove or delete personal files and settings as necessary to reassign the device. The applicant will indemnify the institution for any claims arising from personal data stored on the device.

I understand the data privacy terms and will remove or backup personal data prior to submitting the device for repair or return.

Authorization and Certification

By signing below, the applicant certifies that the information provided is accurate and complete, agrees to comply with all institutional policies related to device use and care, authorizes issuance or repair as requested, and accepts financial responsibility for applicable fees, repair, or replacement costs. If the applicant is a minor, the parent or legal guardian certifies consent to these terms on behalf of the minor.

School Use Only (do not complete)

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