1. Revised 3/21/2007
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
If Request is for Check One Check One
Name Clock Student Interaction
Student Use
Position Assigned Office
Staff Use
Check if
Itinerant
Number Software, the IU8
Replace
New
Tag # is required. *
Signature below denotes approval
*The IU8 Tag number will be located on a white bar code label on or underneath your computer.
______________________________________________________ ______________________________________________________
Supervisor Signature Date Department Director Signature Date
Technology Administrator/Specialist Signature Date