Please submit this form and your laptop to the Wahi Lolouila in the Vice Principals Office

STUDENT SECTION: Todays date: Students Name: Login ID: Safeware: YES NO

Kamehameha Middle School Kaplama Laptop Repair Request

Day Boarder Password:

Laptop Tag No.: (Silver Tag) Is this a loaner? NO YES Loaner # __________ Team: Advisory Teacher: Detailed Description of 1. Problem: ________________________________________________________________ the Problem(s): ___________________________________________________________________________ Please be specific by indicating any ___________________________________________________________________________ error messages, programs in use ___________________________________________________________________________ at the time, frequency of problem, etc. Where did this Building and room # ________________________________ problem occur? Home ______ Other ______ WL and IT STAFF SECTION: Issued Loaner # Date Issued: Signature of Student at Loaner Issue Help Desk Case ID # Date & Time Created Entered by: _________ Date, Name & Signature of Tech at Laptop Pick up: Date, Name & Signature of Tech at Laptop Drop-off: NOTES Date & Time of Student Notification(s): Email Announcement Student Pick-up: Date: Sign: FOR VP USE ONLY: Date & Signature for loaner laptop:

Revised: 8/10/2010