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Lost/Stolen Device Form
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* Indicates required question
Name
*
Full name of person filling out the form.
Your answer
*
If a parent is filling out the form please include student's full name. If a student is filling out the form please include parent's full name.
Your answer
Student's Grade
*
Your answer
Student's Date of Birth
*
Your answer
Telephone Number
*
Your answer
Student's Address
*
Your answer
Was the Chromebook lost or stolen?
*
Lost
Stolen
Not Sure
Date and approximate time device was lost or stolen?
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Where was the Chromebook when it was lost or stolen?
*
Home
School
Car
Other
If other please explain.
Your answer
Please describe in detail any information you have in regards to the device being lost or stolen
*
Your answer
Has a police report been filed?
*
Yes
No
Filing a Police Report
Please contact Office Mike Nelson at the North Branch Middle School. Officer Nelson can be reached at 651-674-1513.
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