Kamehameha Middle School Kaplama Laptop Repair Request Please submit this form and your laptop to Wahi

Lolouila in the VP Office

STUDENT SECTION: Todays date: Safeware: Y or N Safeware #: Circle one: Students Name: Boarder Day Login ID: Password: Laptop Tag No.: (Silver) Team & Advisory Teacher: Detailed Description of the Problem(s): Please be specific by indicating any error messages, programs in use at the time, frequency of problem, etc.

Is this a loaner? Loaner # No Yes Team: Advisory Teacher:

1. Problem: 2. Program in use:

3. Error Message:

4. OTHER Problem(s):

Where did this problem occur?

Building and room # ________________________________ Home ______ Other _____________________________ Loaner# Date issued: Entered by: 1.) 2.) Date: Sign:

VP and IT STAFF SECTION: Loaner # and Date issued Signature of Student at Loaner Issue Help Desk Case ID # From Remedy Date & Time Created Date, Name & Signature of Tech at Laptop Pick up: Date, Name & Signature of Tech at Laptop Drop-off: Date & Time of Student Notification(s): Date & Signature of Student at Pick-up: Cost of Repair & ERD Comments: FOR VP USE ONLY: Date & Signature for loaner laptop: Updated/MKC: 8/4/2011