Help Desk Chromebook Repair Ticket
Your Email
*
example@example.com
Your Email (select from list)
*
Please Select
c_alves@ludlowps.org
j_hedin@ludlowps.org
k_eggimann@ludlowps.org
k_ferrabelo@ludlowps.org
p_targonski@ludlowps.org
s_labadorf@ludlowps.org
vinzorelli_perez@ludlowps.org
School Name
*
Please Select
HS
MS
HB
ES
Staff/Student Full Name
Student Grade
*
Please Select
Gr=K
Gr=1
Gr=2
Gr=3
Gr=4
Gr=5
Gr=6
Gr=7
Gr=8
Gr=9
Gr=10
Gr=11
Gr=12
Library Spare
Staff
CHECK WHO BOUGHT INSURANCE HERE
(Grades 4-12 only)
Does the Student Have Insurance?
*
Please Select
Yes
No
N/A (spare or staff device)
Is the damage Accidental or Mechanical?
*
Please Select
Accidental
Mechanical
Insurance Company Wants to Know How the Accidental Damage Happened (Be as descriptive as possible)
*
Damaged Chromebook Brand/Model
*
Please Select
ACER C771 (Spares)
DELL 3100 (Spares)
DELL 3110 (Grades 8 & 12)
DELL 3120 (Grades 6, 7, 10 & 11)
HP G5 EE (Spares)
HP G6A EE (Spares)
HP G7 EE (Spares)
HP G8A EE (Grades K, 1)
HP G9 EE (Grades 2 & 3, Spares)
HP Fortis G10 (Grades 4, 5, & 9)
LENOVO 14E (STAFF)
ASUS Chromebook CX14 (STAFF)
Damaged Chromebook Serial Number
*
Problem(s) With Chromebook
*
Bottom Cover Broken
Camera Issue
Display Bezel Broken
Display Broken/Cracked
Display Issue
Frame Damage
HDMI Port Issue
Headphone Jack Issue
Hinge Damage
Keyboard Issue
Microphone Issue
Missing OS Issue
Other (Describe Below)
Palmrest Assembly Broken
Runs Slow
Runs Hot
Speakers Issue
Top Cover Broken
Trackpad Issue
USB Port Issue
WIFI Issue
Won't Charge
Won't Power On
Description of Chromebook Issue
*
Take Photo of Damage 1 (must have a web cam)
Take Photo of Damage 2 (must have a web cam)
Upload Pictures Here
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Replacement device is
Permanent
Loaner
Replacement Device Brand/Model
Please Select
ACER C771 (Spares)
DELL 3100 (Spares)
DELL 3110 (Grades 8 & 12)
DELL 3120 (Grades 6, 7, 10 & 11)
HP G5 EE (Spares)
HP G6A EE (Spares)
HP G7 EE (Spares)
HP G8A EE (Grades K, 1)
HP G9 EE (Grades 2 & 3, Spares)
HP Fortis G10 (Grades 4, 5, & 9)
LENOVO 14E (STAFF)
ASUS Chromebook CX14 (STAFF)
Replacement Device Serial #
Replacement Device Issued On:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: