This 3 sentence summary provides the essential details from the request form: The request form is for technology resources from a department, and includes fields for the reason for the request, the resource(s) requested, the requester's name, position, office location, and clock number. The supervisor and department director must sign to approve the request, and the technology administrator will also sign if approved.

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