8/6/2019 WL Repair Request Form 8-4-11

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Updated/MKC: 8/4/2011

Kamehameha Middle School KaplamaLaptop Repair Request

Please submit this form and your laptop to

Wahi Lolouila in the VP Office STUDENT SECTION:Todays date: Safeware: Y or NSafeware #:

Students Name: Circle one:

Login ID:

Password:

Laptop Tag No.:(Silver)

Is this a loaner?No Yes

Team & AdvisoryTeacher: Team: Advisory Teacher:DetailedDescription of theProblem(s):

Please be specific byindicating any errormessages, programsin use at the time, frequency of problem, etc.

1. Problem:

2. Program in use:

3. Error Message:

4. OTHER Problem(s):

Where did thisproblem occur? Building and room # ________________________________

Home ______ Other _____________________________

VP and IT STAFF SECTION:Loaner # and Date issued

Loaner# Date issued:Signature of Student at Loaner Issue

Help Desk Case ID # From RemedyDate & Time CreatedDate, Name & Signature of Tech atLaptop Pick up:Date, Name & Signature of Tech atLaptop Drop-off:Date & Time of Student Notification(s):

1.) 2.)Date & Signature of Student at Pick-up:

Date: Sign:Cost of Repair & ERD Comments :

FOR VP USE ONLY:Date & Signature for loaner laptop: