Date:_____________________

REQUESTOR:_________________________________________DIVISION:_____________________
 
                                                                                                            Phone: ____________________
This form is to be used for recommending instructional software to be acquired by the College. 
Please type or print clearly.  Brochures or flyers may be attached to this form.

CHECK ONE:  ________  For broad access by students

                        ________  For dedicated lab use only       Specify lab number(s):  ___________
       
Name of Software Publisher Version Course related to License Count Existing Licenses Price
             
             
             
             
             
             
             
APPROVED:_____________________________ APPROVED:  ______________________
                            Department Chair  
APPROVED:_____________________________ ORDERED:  ________________________
                           Instructional Dean  
COMPATIBILITY OK:________________________________
Director of Information Technology
 
Comments and other related costs:
(additional server, maintenance contract, etc.)