HCS PDL Device Repair Form Include with each repair request

To be completed by the school:

Date

Student Name

School

Phone Number of Student/Parent

Physical damage to device: Yes

Grade

Unlock Code

No

Staf Initials

KACE W/O #

Insurance: ______Yes_______No Parent notified:

____yes ____No
Choose One: ______Utilize the insurance

_______ Pay for the damage out of pocket

Write a short detailed description of the problem (include any specific error messages):

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Please note that the device may be erased or reimaged. Any files or settings saved on the
device may be deleted during that process. Any files in your Google or Microsoft drive will
not be erased.
For students who have insurance coverage a loaner device may be issued while their device is
being repaired. The
parent must approve use of the loaner device prior to the
device being issued. Insurance does not cover the device on loan.
==================================For Office Use
Only=============================================
Serial Number
Asset Tag (Barcode)___________________ Additional Barcode________

Description of Repair/Repair Notes/Parts Used:

____________________________________________________

Type of Repair:

Warranty

InHouse

Third
Party

Not Repairable

Repair Cost: Parts

Labor

Total

Returned