Technology Order Request Form | Alternative Education

The Process

This request will be sent to your site administrator.
If the site administrator chooses to continue with this request, he or she will forward your request to Technology for an estimated cost for your requested item.
Technology will reply back to the site administrator with the price quote.
The site administrator will need to forward your request and price quote to the director for approval.
If you are an Administrator submitting a request (on the web form), in the "Who is your Immediate Supervisor" field, please choose "dotaylor@kern.org". This is so your request will go straight to Doug 'first'. With your request attached, he will provide you with a price quote. You can then forward your request, with price quote, to Mr. Rojas or Mr. Shannon.

The order request and the price quote will only be good for 2 weeks. After that, Technology will remove the request. Please be in contact with your site administrator (only) for updates on your request.

Requestor's Name*

First Last

Requestor's Work Email Address*

Requestor's Phone Number*

Who is Your Immediate Supervisor?*

If you are an Administrator submitting a request (on the web form), in the "Who is your Immediate Supervisor" field, please choose "dotaylor@kern.org". This is so your request will go straight to Doug 'first'. With your request attached, he will provide you with a price estimation. You can then forward your request, with price estimation, to Mr. Rojas or Mr. Shannon.

Today's Date*

What is the name of the item/software you are requsting? Please be very descriptive.*

Examples: Teacher computer, Student computer, Color Deskjet printer, Black & white laser printer, Network Scanner, All-In-One Printer (blk & wht or color), LCD Projector, 15" laptop, security radios, LCD flat-screen monitor, ceiling mount for my LCD Projector, SmartBoard, Airliner for my SmartBoard, Sub-Woofer speakers for the LCD projector cart, Multi-Media Keyboard, Adobe Acrobat Professional XI, etc.

New or Replacement Item?*

Is the requested item a new item or a replacement item?

New Item
To Replace an Item

What happened to the item(s) that needs to be replaced?*

Quantity of Item*

Please type how many of the items/software-licenses you are requesting.

Program*

Please choose the program that this item will be used. If you don't see the Program in the list, please select "Program Not Listed".

Program Not Listed

If you selected "Program Not Listed" from the field above, please type in the name of the Program.

"Site" the item will be used*

Please select the school site this item will be used. If the site isn't listed, please select "Other Site".

"Other Site"*

If you selected "Other Site" in the form field above, please type the name of the site or location.

Recipient*

Please type the first and last name of receipient of the requested item. If the item is for more than one person, click the + icon to add another row to enter additional names.
One name per line please. If the item is for a student, type "Student Use".

Room Number(s) or Specific Location*

Please be specific

Have you requested this same item before, but it wasn't approved at that time?*

Yes
No

Date previous request was submitted

If you chose "Yes" to the field above, please choose the estimated date this request was previously submitted.

Reason to Purchase / Comments*

Please type the reason for your technology request and how this item will be utilized. To help with the approval process, please be as descriptive as possible.