Refurbished Technology Request
Thank you for your interest in the PATINS Refurbished Technology Program.

Indiana K-12 public school administrators, special education directors, teachers of record, and other school personnel working with students receiving special education services are eligible to apply for refurbished technology to be used by individual students in need, in the classroom and/or home use. A limit of ten devices per school, per year is our policy. Special requests above this must be approved in writing by the PATINS Project State Director, Daniel McNulty. Applications are filled on a first come-first served basis when the appropriate equipment becomes available. Due to the large volume of requests, each request will be evaluated, and potentially filled, based on the justification provided to support Indiana public K-12 students in gaining meaningful educational access and participation. Technology is distributed on an AS-IS basis. PATINS does not provide technical support for the technology once delivered. This service is intended to fill educational gaps for individual students based on their unique need, not to satisfy infrastructure needs for entire classrooms or buildings.
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Full name of requesting educator or service provider *
School Corporation or District Code (Example 84-8435-3309) *
To locate your school code, you can look it up at the DOE web page. http://compass.doe.in.gov/search.aspx?q=
County Name *
Corporation or District Name *
School Name *
Principal and/or Director Name *
Principal and/or Director Phone Number *
Principal and/or Director Email *
Applicant's Work Information
This is the school site where the requested refurbished technology will be used.
School Address *
City/Town *
Zip Code *
Applicant's Phone Number *
Applicant's Email Address *
Applicant's Summer Email Address *
Which describes the setting under which the refurbished technology is going to be used? *
Details of the intended use under which the Refurbished Technology is being requested.
The following section aims at learning more about the intended use of the refurbished technology program and is aligned with outcomes-driven accountability.
Describe the Need *
In a few sentences explain why your student requires the requested refurbished technology. Please provide a rationale, including disability type and why your student needs this refurbished technology to more fully access the general education curriculum.
Identify the Gap *
Please describe the technology that is available to your student at the school. Include a description of any gaps in serving this student with the technology already available. For example, if your school has Chromebooks but an app that supports communication is only accessible on an IPad.
Describe the Request *
Name the type of refurbished technology you believe will better meet the needs of your student and why. PLEASE NOTE: Read any software documentation for the hardware requirements you are intending on using with this student. PATINS will attempt to provide you with the minimum system requirements. However, it should be noted that we can not guarantee the provision of a specified equipment as technology is ever-changing.
Identify the Targeted Outcomes *
After receiving the Refurbished Technology Program sponsored by the PATINS Project how will you know when you are successful?
Follow Up
In order to measure the effectiveness of this program, PATINS Project is required to check-in with you from time-to-time. This may include completing a survey, participation in a online focus-group or providing a verbal statement by telephone of this program's use and impact. Please acknowledge below.
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