Type of Request:  Service Request  Equipment Request    Set-up  Network Password Reset   Email Account Password Reset Contact Information:   Date:         Name:            Person Requesting Service: (if different from above)                Contact Number:        Email Address:       (please enter your entire district email address so we can contact you)

Please enter as many details as possible under the Problem Description. To navigate through the form use the "tab" button, do not hit the enter button until you are ready to submit this form.

Building :  Abraham Clark High School Grace Wilday Junior High School Leonard V. Moore Middle School Dr. Charles C. Polk Elementary School Harrison Elementary School Washington Elementary School Board of Education Office Special Services Roselle Annex - Elizabeth Shims - Roselle Other - Specify below    Other Building Location:

Location/Room #:      

Problem:      

Problem Description:      

Pressing the submit button will automatically send your information to the Technology Department help desk.  Only press submit when your application is complete. If you want to print a copy for your records, print the page that appears after you press submit.

 Please allow minimum of 48 hours for completion of all service requests.