To use this form, you will need the student's id or student number from PowerSchool. It is a six-digit number and identical to student login. (It is also the student's email address with '@edu.bloomfield.k12.nj.us,' as in 123456@edu.bloomfield.k12.nj.us.)

Clink or the document to the left, or the link below. Here is the link for you to bookmark.

You must enter the student's id or student number (this field is required).

Enter the child's first and last name (this will appear in the email to the parent- this field is required).

Select your school (this this field is required).

Indicate whether this is a first, second, or other type of incident (this too will appear in the email to the parent - it is NOT a required field).

Indicate the type of damage that was done (this will NOT be included in the email to the parent- it is NOT a required field).

Include a brief narrative to describe the incident (this will NOT be included in the email to the parent- it is NOT a required field).

Click Submit.

Once you click Submit, an email will be sent to the email of parent/guardian on the Parent Portal, your Principal, and your school Librarian.

You will receive a copy of your submission.

Below is the text of the email:

Dear Parent/Guardian of Joan Jones,

Your child's Chromebook was damaged. We have given him or her a loaner and will send his device for repair. There is no fee for a first incident. Below is the schedule of payments for other incidents:

1st Incident = no cost

2nd Incident = $55.00

3rd Incident = $110.00

4th Incident = $400.00

Lost/Damaged Charger = $55.00

Lost/Stolen Chromebook = $400.00

Fees must be paid before the Chromebook can be returned.

If any questions, please check with your child's teacher, or school librarian.

The fee, if any, should be processed by the school Libarian.

This process is completely independent of the Discipline Referral form in PowerSchool, explained below.