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. *

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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.