Name
*
First Name
Last Name
E-mail
*
Select the Technology being requested
*
Chromebooks
iPads
Surface
Portable Smartboard
Desktops
Projector
# of devices requested
*
Location of Event
*
HAS
HHS
LMK
PAR
PUR
PRE
Room of Event
*
Enter the date of the event
*
-
Month
-
Day
Year
Date
Enter the Time of the event
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Type of Event
Professional Development
Student Program
Teacher In-service course
Other
Reason for request:
*
i.e. PD, Curriculum Writing, Department Meeting, Faculty Meeting, PD, etc.
Submit
For Technology Use only
Supervisor Check
Password
Enter Date of receipt
-
Month
-
Day
Year
Date
Assigned Tech
Steve Engheben
Homer Ferreyra
Michael Hauer
Sadrack Fleurimond
Devin Martindale
Should be Empty: