iPad App Installation Request Form (Paid App)
** This form must be used when requesting to purchase paid apps. Must have evidence of using lite version of app successfully.
** CCESC Administration still has the right to refuse the application installation request even though this form has been completed.
ESC Employee Name *
Your answer
Position *
Your answer
Program *
Enter your e-mail address *
Enter your e-mail address
Your answer
Supervisors Full Name *
Please enter your Supervisors Full Name
Your answer
Supervisor's e-mail address *
Enter Supervisors E-mail Address
Your answer
Enter your assigned building? *
Enter your assigned building.
Enter the name of the App needing installed. *
Enter the name of the app from the App Store.
Your answer
Describe population for which app will be used including age, sex, grade, disability category and any known diagnosis: *
Your answer
Purchase Price? *
Enter the cost of the application from the app store.
Your answer
How many devices will the APP need to be installed on? *
Enter the number of devices that the App needs to be installed on.
Your answer
List the device ID numbers or list the cart ID number? *
(Example:5670 thru 5680 would get the app installed on ten devices. You could also specify the cart ID for the entire cart or set)
Your answer
Purpose of app *
Please enter your purpose for using the app in the classroom or intervention.
Your answer
Will you use this app for its intended purpose? If not please explain below. *
Is the app aligned to IEP or BIP goals? (If yes please list goals. If not just type no) *
Your answer
I have used the free/lite version of this app? *
How long did you trial the free/lite version of the app? *
Your answer
Provide evidence of student progress on IEP and/or BIP goals before and after trial app use. *
(e.g. On IEP goal 1 student was 45% accurate on articulation of /k,g/ before app trial and 60% accurate after app trial)
Your answer
Intervention or strategy to be taught using app:
What outcomes are you expecting to see with the use of this app? *
(e.g. student will increase x skill by 10% to master IEP goals.)
Your answer
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