JSU- ATiM Request for Services
Thank you for your interest in JSU Technology in Motion. Please fill out the following form and someone will be in touch with you as soon as possible. Keep in mind that not all dates can be honored due to prior commitments or obligations, so the more flexible you can be with dates the better. Please note that fields marked with an asterisk (*) are required.
Person requesting workshop
St. Clair County
Name of School(s)
Email of contact requesting workshop
Cell number of contact
(In case I need to contact you prior or on the road)
School or office phone number
Focus of Support
Hardware (Chromebooks, iPads, 1:1, etc.)
Software (Google Apps, Office 365, Learning Management System, etc.)
Digital Citizenship and/or Classroom Management with devices
Subject Area-- Math and/or Science (sites, apps, PBL supported by tech)
Subject Area- Language, Reading, History (sites, apps, PBL supported by tech)
Assessment and/or SAMR technology integration
What date are you requesting? What time will the first workshop begin? (if multiple, indicate at the end)
If training on a single date, choose it again below. What time will the final workshop end that day?
If multiple groups are being trained in a day, how long is the total workshop time? (note: anything less than 45 minutes is difficult to achieve)
45 min - 1 hr
1 1/2 hr -2 hr
2 hr- 2 1/2 hr
Besides the above dates, are there other dates you want considered?
What is the location of the workshop?
Will participants have their own devices or access to them in a lab for this workshop?
What equipment should the specialist bring for this location?
(Example- projector, extension cord, screen, Apple TV, etc.)
Is there a regular schedule you want for training (monthly, quarterly)? Consider your Educate AL surveys, CIP, and other data--- Is there a focus you want me to use to customize training? Also consult my website for some ideas.
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