Student Technology Fee Funding Request Form

CONTINGENCY FUNDING REQUEST FORM

Project Title

(Use a separate form for each project/request)

	Priority Number (Rank multiple submissions from same department/division)
	Category of Request (Choose one/most applicable)	Maintain existing technology Increase student access to technology New technology
	Campus location of request/project
	Department/Division(s)
	Department/Division Manager	Name Email
	Please provide budget ORGN and PROG codes	ORGN     PROG  (6 digits only) (6 digits only)
	Informational Contact Person	Name Email Phone
	Submitted in collaboration with (if applicable)
	Identify if the request has recurring costs	No Yes
	Can this request be partially approved if technology fee funds are insufficient? (Explain in cost breakdown section below.)	No Yes 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)