S O F T W A R E R E Q U E S T F O R M

Name of person making request :

Title Publisher and Version Number:

Lake Shore Curricular Content software supports:

Science	Social Studies Communications

Math	Fine Arts	Physical Education

Media Curriculum	Technical Education	Health

Career & Employability Skills	Research/General Non-Curricular

Special Education

Is District funding being requested?
Source:	Cost:

Standards/Benchmarks software supports or justification if not curricular: Identify applicable (use reverse side if necessary):

Reviewer’s Comments

Minimum hardware requirements:

Type of computer (make and model #) where it will be installed:

Grade Level	Building

Requester’s Signature___________________________________ Date__________________________

Building Administrator Signature__________________________ Date__________________________

Reviewed by: (reviewer initials and dates)

Curriculum/Instruction__________________________________ Date__________________________

Technology___________________________________________ Date__________________________

(Send original to the Technology Department; Keep a copy for your records)

DRAFT

SStanley

2004-09-22

Lisa M. Spotts

Lake Shore Public Schools