Mr. Fulmer

This form is for students in grades 6-8 that are having computer problems. It is VERY
IMPORTANT to document when exactly the computer problems first occurred, how often the
problem is happening, and what you were doing when the problem occurred. The more
information you provide, the easier it will be to solve your problem.

• 1) Computer #
  Answer:
• 2) Dates/Times problem occurred
  Answer:
• 3) How often the problem has happened
  Answer:
• 4) What were you doing at the time the problem occurred? (What program were you using or
  what action were you performing?)
  
• 5) Are you still able to use your computer or is this a problem that requires immediate
  attention?