Petition to the Indiana State Board of Education for Funds from the School Technology Advancement Account Fiscal Year 2025

Created for Teresa Hemmerle by Don Gilroy on 05/31/2023.

Petition to the Indiana State Board of Education for Funds from the School Technology Advancement Account
Fiscal Year 2025

Applications are due by 4:00 p.m. on Friday, July 12, 2024.

1. Corporation No:*

Corporation Name:*

Contact Person:*

PrefixFirst NameLast Name

Contact Email:*

Confirmation Email

2. Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

3. The amount not to exceed that determined under the following formula:

STEP ONE: DOE-PE 2023-2024 enrollment*

STEP TWO: Divide STEP ONE by 25*

STEP THREE: Multiply STEP TWO by $500 - Eligible Amount*

4. If there are remaining STAA funds available, please check here to be considered for additional funds, if available*

YesNo

5. Amount requested in additional funds $*

6. Total $ Amount*

7. Please provide a brief description of the additional project components to be funded and a breakdown of the cost by building.*

8. Does the school corporation have a current approved 3-year technology plan on file with the Department? *

YesNo

If the school’s three year technology plan is not on file or has been updated, please send a copy to CommonSchoolFund@doe.in.gov

9. Project Cost Breakdown

a. Technology $*

b. Other project cost (please describe)*

---- b. Enter the Amount $*

c. Other project cost (please describe)*

---- c. Enter the Amount $*

d. Total $ project cost (sum lines a through c)*

Sources of funds used to finance the project:

e. Common School Technology Loan $*

f. Other (describe)*

---- f. Enter the Amount $:*

g. Total $ sources of funds (line e plus line f) *

10. Please answer the following questions:

a. Outstanding principle amount of all obligations for the school:*

b. Current debt service tax rate:*

If your corporation is applying for funds to purchase computer hardware and software for student instruction, complete Form STAA-A.*

YesNo

Form STAA-A Petition to purchase of computer hardware and software for student instruction

1. Briefly describe the computer hardware and/or so*

Project Breakdown*

2. Briefly cite evidence that said hardware and/or software will be used primarily for student instruction.*

Your corporation is applying for funds to develop and implement an innovative technology project, complete Form STAA-B.

Form STAA-B Petition to Develop and Implement Innovative Technology Projects

1. Check either or both:*

Project will introduce new technology to the school corporationProject will introduce new methods of instruction to the corporation

2. Briefly describe the new technologies and/or new methodologies being introduced:*

3. Briefly explain how the project is expected to advance student learning and achievement?*

4. Briefly describe the method(s) which will be used to evaluate the degree to which the above stated goal is achieved.*

5. For each budget category below, state the dollar amount to be spend and briefly describe the goods or services to be purchased:

	Contracted services	Hardware	Materials/Supplies	Personnel	Other
Amount $
Description

Preparer's Name:*

Date*

MonthDayYear

Upload File(s): Upload signed certification page and any other pertinent supporting documentation for the project here.*

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