1. USD #261 Instructional Technology Request Form
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USD #261 Instructional Technology Request Form
 
Name                    Date      
Position/Building Assignment        
Have you discussed this instructional technology request with an administrator/tech team leader? Yes   No
 
Request Description
     

Provide Rationale for your request that is tied to one or more building and/or district goals that relate to school improvement, student achievement, and/or the USD #261 Strategic Plan. (What will you do with the requested item(s) to directly support the instructional program?)



     
 
How many students will be impacted by the implementation of the requested instructional technology?      
How will the requested instructional technology be used with at-risk/low achieving students?      
Are departmental funds available for this request?      
 
Is this request to upgrade or replace an existing piece of equipment or software ?   Yes No
If yes, what are you unable to do with the equipment or software that you currently have available?



     
 
What is the level of urgency and/or desired timeline for this request?
       
 
What is the action plan for implementation of this request (training/staff development, set up, installation, etc.)? Be as specific as possible.



     
 
Are you aware of any on-going expenses that may be associated with this request (subscription fees, maintenance, etc)?



     
 
Additional comments/questions:

     

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Upon completion, submit this request form to your building instructional technology team leader. For district level requests, submit the form to Lisa Cundiff ( lcundiff@usd261.com ).