Refurbished Technology Request
Thank you for your interest in the Refurbished Technology Program. Due to the large volume of requests, each request will be evaluated and filled based on supporting students in gaining meaningful educational access. Please fill out the following application to request Refurbished Technology. The Refurbished Technology Program is sponsored by the PATINS Project.
Full name of requesting educator or service provider. *
Your answer
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=
Your answer
County Name *
Your answer
Corporation or District Name *
Your answer
School Name *
Your answer
Principal and/or Director Name *
Your answer
Principal and/or Director Phone Number *
Your answer
Principal and/or Director Email *
Your answer
Applicant's Work Information
This is the school site where the requested refurbished technology will be used.
School Address *
Your answer
City/Town *
Your answer
Zip Code *
Your answer
Applicant's Phone Number *
Your answer
Applicant's Email Address *
Your answer
Applicant's Summer Email Address *
Your answer
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, include disability type and why your student needs this refurbished technology to access more fully the general education curriculum.
Your answer
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.
Your answer
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.
Your answer
Identify the Targeted Outcomes *
After receiving the Refurbished Technology Program sponsored by the PATINS Project how will you know when you are successful?
Your answer
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.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy