Requested by      Title
E-Mail Address     Date 
School      Phone Number 
Software Title   Version  
Manufacturer 
Software Vendor     Estimated Cost
Is this a web-based program requiring a yearly subscription?  Y  N           If "Yes", cost per student 
Funding Source  --Select One-- Bond Student Activity Title Other             If "Other", describe 
Is this an upgrade to a previously approved software package?  Y   N
Yearly tech support available on this software?    Y     N  
 If “Yes,” have you earmarked funds to purchase and renew it?    Y     N

Curriculum Area(s) Where Software Will be Used (Check all that apply)

Math     Science    Lang. Arts    Reading    Soc. Studies    Music    Visual Arts    PE    ELL
Foreign Languages    Special Ed    Career Tech   

Grade Level(s)  (Check all that apply)
Pre-K   K    1st   2nd   3rd   4th   5th   6th   7th  8th   9th   10th   11th   12th

Specific Benchmark(s)/Standard(s) to be Addressed


Training:
If a site is purchasing the software, what are the plans for user training?


System Requirements:
Processor:  Pentium 3   Pentium 4   Other
Software Will Run On (Check all that apply):   WIN 2000      WIN XP      WINDOWS NT
Software Version (Select  one only)      Network      Single Station
Minimum RAM               Hard Drive Space Required              Sound Requirements?  Y    N

Principal's Approval
Name of Principal Who Has Approved This Request 

Approval Process:
This software request will be routed through (1) Curriculum Specialist Resource Teacher, (2) Software Committee, and (3) ISS.
_________________________________PLEASE DO NOT WRITE BELOW THIS LINE______________________________________

Curriculum Specialist
Approved    Not Approved   Date

Software Committee
Approved    Not Approved   Date

ISS Representative
Approved    Not Approved   Date