Richmond Public Schools



Richmond Public Schools

Mobile Device/Computer Accountability Form

I, _______________________, accept responsibility and accountability as stated in Richmond City Public School’s Acceptable Use Policy and Mobile Device/Computer Acceptable Use Policy.

Upon seperation from Richmond Public Schools, I agree to return all issued devices and accessories.

I agree that the following devices and accessories, in the said condition, have been issued to me by Richmond Public Schools on the date specified.

RPS Asset Number: ________________ Serial Number: ______________________

Make/Model: ______________________

Check one of the following issued devices:

____ Computer New ___ Repurposed____ Donated____

____ Laptop/Mobile Device New ___ Repurposed____ Donated____

____ Printer New ___ Repurposed____ Donated____

____ Other: ____________ New ___ Repurposed____ Donated____

Check the issued accessories:

____ Power Supply & Cord New ___ Repurposed____ Donated____

____ Mobile Device Bag New ___ Repurposed____ Donated____

____ Other: ____________ New ___ Repurposed____ Donated____

Employee Name: _______________________________________________________

Phone: _________________ Employee ID # __________ Location: _____________

Email Address: ________________________________________________________

Signature: __________________________________ Date: _____________________

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