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BCS - Request for Use of Personal Device

BCS - Request for Use of Personal Device

This form must be approved each year by the Technology Department.
A copy of the approved form will be kept on file in the BCS - Central Office Technology Department.
BCS Technology Department, may contact you about any issue concerning your device and may request permission to search the device for activity or request the device be removed from the premises at anytime.

Date:*

Today's Date

Answer Required

Employee Name:*

First and Last Name

Answer Required

Employee Cell Phone #:*

Where you can be reached for further questions

Number Required

Employee BCS Email Address:*

Answer Required

Assigned Location:*

Employee's assigned work location

Answer Required

Make/Model:*

Make: Ex: iPad / Model: Ex: MGJU2LL/A1657

Answer Required

Device Serial #*

Ex: on the back or bottom of iPad/Laptop

Answer Required

Rationale for Use of Personal Equipment:*

Answer Required

Read and select each item in order to acknowledge your agreement:*

All items must be selected - for approval process

Answer Required

In order to comply with the district eRate certifications, I affirm that this equipment will be used solely for educational purposes while in the school.

When using this equipment, I agree to abide by the BCS Acceptable Use Policy #1021, Use of Internet and Internet Safety.

I acknowledge that this equipment can be searched at any time.

I understand Bartlett City Schools does not assume liability for this equipment.

I understand that Bartlett City Schools is not responsible for providing technical support or for installing software on personal devices.

I agree to provide all of the necessary hardware, software and cables, excluding networking devices or switches. If networking device or switch is required, it must be provided by the school.

My school ITC or TST has confirmed that my computer system has an up-to-date commercial virus protection program. Computer Associates eTrust antiviruse or Sophos antiviruse is recommended.

I will request a review by the ITC or TST each semester, to assure that my virus protection is current.

I understand that my equipment must use a static IP number for network access, and a number will be provided within a specified range as determined by the BCS Technology Department.

Position*

Title (Ex: Student Teacher, Company name/ Title)

Answer Required

Signature*

Typing your name below acknowledges your agreement to this document.

Answer Required

Confirmation Email

Confirmation Email *

Email Required