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Technology Request Form

Requestor:

Phone Number:

Related Courses/Programs
Number of Students Benefiting Per Year

Is/are this/these item(s) currently available on campus?
If this/these item(s) are available, do you have access to them?

What types of services will you need with this request?
 
Comments
Training
Software
Equipment
Software Installation
Hardware Installation
Wiring
Other: (Specify below)  

 

Additional purchases required to incorporate this technology into the curriculum. (Purchases that are not covered by the Technology Grant.)
 
Comments
Software
Equipment
Other: (Specify below)  

 

Need/Justification for Purchase (Provide justification for each item):
Item Description/Brand
Company
Phone#
FAX#
Address
City, State ZIP
E-mail
Website address
Justification:

 

Item Description/Brand
Company
Phone#
FAX#
Address
City, State ZIP
E-mail
Website address
Justification:

 

Item Description/Brand
Company
Phone#
FAX#
Address
City, State ZIP
E-mail
Website address
Justification:

 

Please note: A detailed plan will have a better chance of being funded.