Eastern Townships School Board
Enhanced Leaning Strategies
Computer Loss/Damage Report
Staff/Student Name: _____________________________ Date of Loss/Damage: _______________________
Home Room Teacher’s Name: _____________________________ Laptop Serial Number: ____________________
Date the laptop was issued: ___________________________
Statement of the circumstance of loss/damage by holder of the laptop:
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(Include additional pages if necessary)
Signature Laptop Holder: _______________________ Date: _____________________
Signature of Parent (If necessary): ________________________ Date: ____________________
Police Report # (Mandatory in the case of theft): ________________________________
Principal’s Recommendation:
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Principal’s Signature: __________________________________ Date:_______________________________