Student Technology Fee Funding Request Form Contingency Funding Request Form(Use a separate form for each project/request) Project Title Priority Number - None -12345 Rank multiple submissions from the same department/division 1 = highest priority in relation to other submissions 5 = lowest priority in relation to other submissions Category of Request Maintain existing technology Increase student access to technology New Technology Choose the one that is most applicable Location of project requested Department/Division Manager Please provide budget ORGN and PROG codes ORGN 6 digits only PROG 6 digits only Request Lead Contact Name * First and Last Name Email * Phone Submitted in collaboration with Does this request have recurring costs? Yes No If so, at what minimum cost? Total amount of request Description of the need or intended use Number of students (per year) who will benefit Description of the benefit to students Description of how this use fits in with other unit or college technology plans Cite specific college plan article(s) and section(s) Cost breakdown, including any unit resources being applied to the project Hardware, Software, Wiring, Installation, Costs, Timesheet, Staffing, Licensing, Other (Specify) Leave this field blank
