NCDAC Education Services Technology Vet and Requisition Form

Education Services Technology Vetting and Requisition Form
Please provide a response for each field that applies. Web Applications, Links and Apps that are approved will be "Whitelisted" and available for all facilities. Physical items will require vetting for each facility that will house the new technology. Vetting timelines vary, and will be subject to other NCDIT priorities. Form submitters will receive correspondence and updates throughout the process. When complete, please click the submit button.
Name of Person Submitting Form

First NameLast Name
Name of Institution or Section
Community College/4-Year College/ Affiliation/Partnership
Email Address
example@example.com
Office Phone
Please enter a valid phone number.Format: (000) 000-0000.
Date of Form Submission

MonthDayYear
Date
Position Title
Type of Technology
If this submission is for an educational website, have you checked the whitelist to see if this site has already been submitted by another institution or post-secondary partner?
Enter the Website Address, Application, URL or App Address (www.#######) of the site(s) to be vetted.
Brand Name of Technology or Company and Specific Model (Lenovo, Dell, HP, etc.)
If this does not apply please input N/A (Non-Applicable)
Purpose and Justification for Utilization (Please Be Specific)
I
Number of Devices Desired
If this does not apply, please input N/A (Non-Applicable)
Target Audience
Cost of Technology Device, Web Application, or App
If There is a Cost, Subscription or Fee, Please Describe the Payment Source and Process in Detail
YesNoNot Sure
YesNoNot Sure
PDF File Upload-Specifications (Check with Vendor)

Cancelof
PDF File Upload-Image of Device/Software/Hardware

Cancelof
Additional Comments (Optional)
For Software Only: Does the software vendor have 3rd Party Verification that protects personal identifiable information?
For questions, comments or concerns, please contact Travis D. Cooper electronically at travis.cooper@dac.nc.gov or by phone 984-204-2846.
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Education Services Technology Vetting and Requisition Form