Student Device Checkin
Name
*
First Name
Last Name
Grade
*
9
10
11
12
Device Serial Number
*
Found under the Settings, then General, then About
What is the current state of the Device
*
Ready for next year
Broken or damaged screen that needs repaired
Software problems
Please describe the damage and how it occurred
Please describe problems that you are having with it
Are you returning a charger?
*
Yes
No
I understand that I am liable for replacing this charger
Yes
Is there any other information that the technology department might need to know about your Device?
8th Period Teacher
*
ABostwick@pdys.org
TBuckenmeyer@pdys.org
ACarrizales@pdys.org
MCarrizales@pdys.org
MCurrier-Ford@pdys.org
DDixon@pdys.org
GDurfeyDzenis@pdys.org
MEgan@pdys.org
LEisel@pdys.org
MEngel@pdys.org
DHeban@pdys.org
MHess@pdys.org
BHisted@pdys.org
NJames@pdys.org
RKane@pdys.org
ALeininger@pdys.org
DLohman@pdys.org
CMcConkey@pdys.org
SRayfield@pdys.org
RRipke@pdys.org
ERobertson@pdys.org
LRoe@pdys.org
ARoth@pdys.org
NRuple@pdys.org
AVonScoy@pdys.org
JWolford@pdys.org
AWolpert@pdys.org
JYoung@pdys.org
Signature
*
Clear
Date
*
-
Month
-
Day
Year
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