Run Student Device and Chromebook Loan Agreement and Damage Log — Free

Submission Notice and Privacy Disclosure

I understand this form records student device issuance, acceptable use, and any damage or loss for accountability purposes. (required)

Yes No N/A

Consent to collect and store student and guardian PII for device management (required)

This information will be used only for device assignment, contact, repair, return, and audit trail purposes.

Yes No N/A

Submission Type (required)

Student and Guardian Information

Student Full Name (required)

Student ID (required)

Grade Level (required)

School Name (required)

Parent/Guardian Name (required)

Parent/Guardian Email (required)

Parent/Guardian Phone (required)

Device Issuance and Accessory Details

Issue or Return Date (required)

Device Type (required)

Device Asset Tag (required)

Serial Number (required)

Accessories Issued or Returned

Accessory Notes

Use this field only if an accessory is missing, damaged, or replaced.

Acceptable Use and Care Agreement

I agree to use the device for school-related purposes and follow district acceptable use rules. (required)

Yes No N/A

I agree to keep the device charged, protected, and free from food, liquids, and unauthorized modifications. (required)

Yes No N/A

I understand the device must be returned when requested, at the end of the loan period, or upon withdrawal. (required)

Yes No N/A

I understand the family may be responsible for repair or replacement fees when damage or loss is not covered by policy. (required)

Yes No N/A

Does the student need any device-related accommodation or support? (required)

Accommodation or support details (required)

Include only device-accessibility needs relevant to the loan agreement.

Damage, Loss, or Repair Log

Date Damage or Loss Was Discovered (required)

Incident Type (required)

Incident Description (required)

Describe what happened using observable facts only.

Where Was the Issue Discovered?

Estimated Severity

Repair or Replacement Needed? (required)

Temporary Device Issued?

Supporting Photos

Upload only if needed for repair documentation or inventory verification.

Acknowledgment and Sign-Off

Submitted By (required)

Submitted By Role (required)

Signature (required)

Additional Notes

Use this field for brief, relevant notes only.

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Run: Student Device and Chromebook Loan Agreement and Damage Log

Submission Notice and Privacy Disclosure

Student and Guardian Information

Device Issuance and Accessory Details

Acceptable Use and Care Agreement

Damage, Loss, or Repair Log

Acknowledgment and Sign-Off

Get your results