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Request for Technology Resources Department: Supervisor: Reason for Request: Technology Resource Requested: Desktop Computer Hand Held Laptop Computer Printer LCD Software (other than MS Office and e-mail) Other Name Position Clock Number Assigned Office If Request is for Student Interaction Software, the IU8 Tag # is required. * Check if Itinerant New Replace Staff Use Student Use Signature below denotes approval ______________________________________________________ ______________________________________________________ Supervisor Signature Date Department Director Signature Date Technology Administrator/Specialist Signature Date Check One Check One Revised 3/21/2007 *The IU8 Tag number will be located on a white bar code label on or underneath your computer.

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Request for Technology Resources

Department: Supervisor:

Reason for Request:

Technology Resource Requested:

Desktop Computer Hand Held

Laptop Computer Printer

LCD

Software (other than MS Office and e-mail)

Other

Name

Position

Clock

Number Assigned Office

If Request is for

Student Interaction

Software, the IU8

Tag # is required. *

Ch

eck

if

Itin

eran

t

New

Rep

lace

Sta

ff U

se

Stu

den

t U

se

Signature below denotes approval

______________________________________________________ ______________________________________________________ Supervisor Signature Date Department Director Signature Date Technology Administrator/Specialist Signature Date

Check One

Check One

Revised 3/21/2007

*The IU8 Tag number will be located on a white bar code label on or underneath your computer.