Device Acceptance Form

Device Acceptance Form
Parent Name*

First NameLast Name
Parent Email*
example@example.com
Parent Cell Phone*
Please enter a valid phone number.
Student Name*

First NameLast Name
Student School*
Student Grade*

Do you have Internet access at home?

YesNo

Please review the ASD Device Acceptance Agreement.
The ASD Acceptable Use Policy allows students to use technology inside and/or outside of the classroom. I have reviewed the ASD Student Technology Handbook and understand the rules and guidelines including the Financial Terms of device Agreement – the Technology Fee is $25 and is non-refundable.

Terms of Agreement

The student is responsible at all times for the care and appropriate use of technology. I understand if my student violates the guidelines agreed to in the ASD Student Technology Handbook, his/her privilege to use technology may be restricted or removed and he/she may be subject to disciplinary action.

I understand that I may be held responsible for reimbursement for loss, damage, or repair of my student’s mobile device, which may have occurred at school, at home, or while the mobile device was being transported. I understand that while in my student’s possession, the student must abide by the ASD Acceptable Use Policy and ASD Student Technology Handbook.

The device remains the property of the Alcorn School District. In the incident that the assigned device listed below cannot be repaired, ASD has the right to assign a replacement device. At the end of the school year or upon transfer from the District, parents and students agree to return the device to the District in the same condition it was issued to the student less reasonable wear.

As a Student being provided an ASD device:
- I understand and will follow the policies established in the ASD Technology Handbook.
- I will follow the guidelines listed in the Technology Handbook for proper care of the device.
- I will report to school authorities any problems/issues I discover while using the device.
- I understand that resetting the device to factory settings may occur as a result of any repairs or modifications on the device, and this reset may result in the loss of data.
- I understand that it is my responsibility to turn in my device for periodic inspections throughout the school year as requested.
- I understand that the primary use of the device is as an instructional tool.
Students will receive either:

- 2020 120 GB MacBook Air 13.3 inch (Model A2179) - $721.00
- Apple 30W USB-C Charging Block - $49.00
- Apple USB-C Charging Cable - $29.00

OR

- 8th or 9th Generation iPad (Model A2270) - $373.00
- Logitech Rugged Combo 3 - $99.95
- Apple USB AC Adapter – $20.00
- Apple USB Cable – $20.00
Parent/Guardian understands student will take possession of the ASD assigned device and accessories on school specified deployment date.
Parent Signature

Clear
Should be Empty:

Device Acceptance Form

Please review the ASD Device Acceptance Agreement.

Parent/Guardian understands student will take possession of the ASD assigned device and accessories on school specified deployment date.