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Boston Public Schools Office of Instructional Information Technology Tel 617 635-9200 L4L Laptop Return Form Employee Information Name of User Title/Position Employee ID School/Dept RC Manager User phone Reason for Return Please check all that apply Long Term Leave of six 6 months or longer. Eligibility status has changed. Missed the deadline for registration and software updates. Opting out of L4L program. User no longer wants the responsibility of this machine. Please complete an L4L Opt-Out Form. Other Pls specify OIIT is not responsible for any data or software loaded on the machine and does not guarantee the return of this machine upon redeployment. Boston Public Schools Office of Instructional Information Technology Tel 617 635-9200 L4L Laptop Return Form Employee Information Name of User Title/Position Employee ID School/Dept RC Manager User phone Reason for Return Please check all that apply Long Term Leave of six 6 months or longer. Eligibility status has changed* Missed the deadline for registration and software updates. Opting out of L4L program* User no longer wants the responsibility of this machine. Please complete an L4L Opt-Out Form. Other Pls specify OIIT is not responsible for any data or software loaded on the machine and does not guarantee the return of this machine upon redeployment. Item s Condition Item Date of Return L4L MacBook // Infrared Remote Lockdown Device Plug Head Additional Info Extension Cord As it Applies Adapter Asset Tag Case Condition Good Fair or Damaged Signatures/Approvals I understand that if upon receipt it is found that this machine is not in good working condition an investigation will be launched to determine if it is a result of the employee s failure to comply with OIIT s laptop security guidelines for Laptops for Learning or because of the employee s intentional act the employee assumes full financial responsibility for the assessed equipment per the Laptop Use Agreement. For other instances of loss or accidental damage employees will be responsible for a lesser fee this includes the cost to replace missing peripheral items i*e* remote plug head extension cord case lockdown device. User Signature Date RC Manager Signature OIIT Name OIIT Signature For OIIT Use Only Track-it/Casper Lock Reset to 0000 Return Location Campbell Madison Storage Location Court St* Bin Rm. Boston Public Schools Office of Instructional Information Technology Tel 617 635-9200 L4L Laptop Return Form Employee Information Name of User Title/Position Employee ID School/Dept RC Manager User phone Reason for Return Please check all that apply Long Term Leave of six 6 months or longer. Eligibility status has changed* Missed the deadline for registration and software updates. Opting out of L4L program* User no longer wants the responsibility of this machine. Eligibility status has changed* Missed the deadline for registration and software updates. Opting out of L4L program* User no longer wants the responsibility of this machine. Please complete an L4L Opt-Out Form. Other Pls specify OIIT is not responsible for any data or software loaded on the machine and does not guarantee the return of this machine upon redeployment.

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