TEMPLATE
Tech Support Request Form

Building:   * SCHOOL NAME HERE

Room Number:   *

Specify Which Computer (If more than one in room): 

Email Address:   *

Operating System: * CHOOSE ONE Windows 9X Windows NT Windows 2000 Windows XP OTHER

Network Administrator Notified? * YES OR NO YES NO    

Level of Severity: * CHOOSE ONE HIGH MEDIUM LOW
 

1. HIGH: Directly impacts student learning, or implementation of state mandates.
2. MEDIUM: Inhibits delivery of instruction, or inconveniences users ability to perform non instructional duties.
3. LOW: Needs attention, but is not critical to the education process. 

Problem Description: *
Briefly Describe the Problem: Specify any error messages, codes or symptoms below:

  Feel free to print the form result after clicking the submit button.