Technology Responsibility Form (ENG & SPA)

South Bend Community School Corporation
Migrant Regional Service Center - Region #1
Student/Parent/Staff Technology Asset Responsibility Form
(Applies to parents of students who are assigned district technology assets or equipment)
South Bend Community School Corporation - Bylaws & Policies
7530 - LENDING OF CORPORATION-OWNED EQUIPMENT
The School Board believes that Corporation-owned equipment is a valuable resource which may be loaned for community use under certain conditions only, provided that such use does not infringe on the original and necessary purpose of the equipment or interfere with the educational program of the Corporation.
The Board may lend specific items of equipment on the written request of the user and approval granted by the Superintendent
The user of Corporation-owned equipment shall be fully liable for any damage or loss occurring to the equipment during the period of its use, and shall be responsible for its safe return.
Corporation equipment may be removed from Corporation property by students or staff members only when such equipment is necessary to accomplish tasks arising from their school or job responsibilities. The consent of the Superintendent is required for such removal.
By signing this form, the undersigned acknowledges full responsibility for all information listed. If the student is under 18 years of age the Parent or Legal Guardian must Initial each item below.

Student/Parent/Staffwill:*

	Yes	No
Follow all parts of South Bend Community School Corporation Bylaws & Policies listed above.
Acknowledge responsibility for asset’s physical condition.
Safeguard and provide for physical security of the asset.
Read and understand the guidelines listed below referring to lost, stolen or damaged devices: a) Individuals found to be negligent for lost, stolen or damaged devices are responsible to pay market value for that device. b) Individuals agree to pay for a lost, damaged or stolen equipment. (Could up to $1500 in some cases). c) Individuals found liable further agree to pay the district in full or begin payments within 30 days of notification but no later than the end of the current school year whichever is shorter.

Student/Family or Staff (Receiving)
First NameLast Name
COE#
COE Expires
MonthDayYear
Date
Device Information
Note: If you're issuing more than 1 device, please use the field comments to write all serial numbers.
Device Type*
Device Serial/s #
Comments
Picture with Serial/s
Cancelof
Parent/Guardian Name*
First NameLast Name
Signature*
Clear
Intake by*
MRSC Staff
Should be Empty:

South Bend Community School Corporation