Tech Request (New) abbreviated This form is for KLSD employees to request software or website use to be available in the District. Please complete the form for each piece of software you would like to request. NOTE: All requests are tentative based on review of compatibility, appropriate funding, and licensing information. Question Title * 1. Name/Title: (If you are applying for more than one individual, please list all user names). Question Title * 2. Building (Check all that apply) IMES KES MPES JJMS JJHS Question Title * 3. Direct Phone Extension Question Title * 4. Name of Software/Website Requested: Question Title * 5. Software download available Yes No I don't know N/A Question Title * 6. Software Publisher Website and website link: Software Publisher Website Question Title * 7. Please enter the software Version Number (or “I Don’t Know” or “Latest” are examples) Software Version Number: Question Title * 8. Main use for software/Website: Curriculum Enrichment Technical Support Office/Administrative Other (please specify) Question Title * 9. Planned use of software/website - please click those that apply: a) KLSD Learning Commitment and/or b) Department Goal(s) and/or c) Content Standards Question Title * 10. How will this software/website benefit student learning? Question Title * 11. Software/Website included methods to monitor student progress (reports for student and/or family) Yes No I don't know Question Title * 12. Enter the # of students who will be impacted by using this software/website: Question Title * 13. Number of licenses requested (please be specific: number per building, and if there is a building or district license being requested. Question Title * 14. Where do you want the software/website access installed (please be specific, room number, exact computers)? Question Title * 15. How will you evaluate the effectiveness of the software/website? Question Title * 16. What kind of log in does the software/website have? Student log in Teacher log in Student and Teacher login Other (please specify) Question Title * 17. Is the software /website free? Yes No Question Title * 18. Cost of intial software/ website access and projected maintenance costs (renewals, upgrades, etc....) Question Title * 19. Funding Source: Question Title * 20. Does this software/ website need to be renewed annually? Yes No Question Title * 21. Date Required Needed for the next academic year (fall) Other (please specify) Question Title * 22. Have you read the data privacy for the software/ website? Yes No Question Title * 23. Please insert the website link to the data privacy page: Question Title * 24. Where did you find out about this software/ website? Have you used it before? Question Title * 25. Has this software/ website been approved by an administrator? If Yes, please add the name of the administrator in the "other" space below No Other (please specify) Question Title * 26. By typing your name below, you are confirming that you read the Requesting Software Procedure criteria and overview regarding this software/ website request. Done