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Cuesta College - ITTF Request Form

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Instructional Technology Request Form
1 | Page
Instructional Technology Form Directions
The Instructional Technologies Task Force (ITTF) will receive and review recommendations from faculty about web
applications, desktop software and hardware technology that directly support learning / teaching. The form is necessary
to ensure non-campus standard hardware / software is compatible with district standards, existing equipment, as well
as the campus learning management system. The Instructional Technologies Task Force will make recommendations to
the Technology Committee to develop campus standards and implementation timelines of requested web applications,
desktop software and hardware.
About This Form
This form was created to establish a standard process for the acquisition of non-campus standard hardware and
software. It will improve communication to all constituents impacted by this acquisition. This form can be linked to your
program review process and serve as a recommendation.
When Do I Need to Complete This Form?
This form is to be completed ANYTIME a faculty member is interested in using or acquiring any non-campus standard
instructional technology web applications, desktop software and hardware. It needs to be completed prior to any
agreement to terms of service, purchase order, donation, or grant submission!
Who Should I Call If I Have Questions?
Any questions about the form or the process should be directed to the Technology Committee.
How Do I Submit the Form?
You can download the fillable form, complete the faculty page (page 2) and then submit it as a ticket to information
technology using the campus ticket system in mycuesta. You may review pages 3 & 4 for reference on what IT and the
ITTF will be using to review and make recommendations, which might help you complete the faculty page.
What Happens After I Submit the Form?
The Technology Committee will forward the request to IT and the Instructional Technologies Task Force. They will
review the form, provide additional information regarding the acquisition, and make notes about the compatibility on
campus as well as ADA/508, and legal compliance. The committee will decide if the request is approved or not and
communicate the decision back to the requestor.
Helpful Hints When Completing the Form
o Complete the contact information section so that the committee has someone to contact with any questions.
o Provide as much information as possible in the description so the IT Department and Instructional Technologies
Task Force can locate the proper web applications, desktop software and hardware being requested and request
a demo.
o If you are requesting a new non-campus standard web application or desktop software to the district and need
assistance in selecting the best product or vendor to meet your needs, involve the Instructional Technologies
Task Force in your decision-making process.
o The Impact of Student Learning and Staff Development sections are critical components of this form. Be sure to
provide good, sufficient rationale.
o ADA / 508 Compliance is critical, even if the hardware or software is not fully compatible, please identify what
you can do to ensure accommodations are made.
Instructional Technology Request Form
2 | Page
Faculty Contact Information – to be completed by the requesting faculty member.
Name: __________________________________________________________ Date of Request: ___________________
Department: ___________________________ Additional Requestor(s)_______________________________________
When would you like to start using technology: □ Fall 20____ □ Spring 20____ □ Summer 20___
INSTRUCTIONAL TECHNOLOGY INFORMATION
Type and Quantity: □ Web Application _______ □ Desktop Application ______ □ Hardware _______
Description
(Brand, Model #, Version etc. Describe the hardware or software; provide website or other information):
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Where will it be used? □ Individual Classroom □ Online □ Faculty Use
IMPACT ON STUDENT LEARNING
How does this hardware/software fit into the district-approved curriculum?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
How will this hardware or software be used to improve student learning?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Please explain how the hardware or software meets 508 and WCAG 2.0 Compliance or report any accessibility
concerns and how you will make accommodations?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
How will you assess that this tool has impacted student learning?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Administrator’s Approval (Dean or Director): _______________________________________ Date: ______________
Forward your form to the Technology Committee to be completed by
Information Technology and reviewed by the Instructional Technologies Task Force.
Instructional Technology Request Form
3 | Page
INFORMATION TECHNOLOGY USE ONLY
DISTRICT INFORMATION
Location(s) to be installed (building#, room #, workstation #, LMS)
_____________________________________________
Installation Cost(s) _______________________________
Budget: □ District □ Building □ Other _____________________________________________(Specify- Donation, Grant,
etc.)
Identify any continuing hardware costs (replacement cost, bulbs, etc.)
________________________________________________________________________________________________
# of licenses needed: ______________________________________________________________________________
License options available:
□ Single $ _________ □ Lab Pack (Qty.: ___ ) $ __________ □ Site (Qty: ___ ) $ _________
Type of License:
□ New to the district □ Upgrade of an existing license □ Additional licenses of existing software
VENDOR INFORMATION
Vendor Quote#: ___________________ (please attach quote) Name of Vendor:______________________________
Contact: ______________________________ Phone: ____________________ Website: ________________________
Address: ________________________________________________________________________________________
IT Comments / Notes:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
IT Approval: _________________________________________________________________ Date: ______________
Instructional Technology Request Form
4 | Page
TECHNOLOGY COMMITTEE USE ONLY
FACULTY / STAFF DEVELOPMENT
● What training is needed to implement this hardware/software?
_______________________________________________
● When & how will training be accomplished?
___________________________________________________________________
● Is training available from the vendor? □ yes □ no Associated cost?
__________________________________________
Additional Comments:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
ADA - 508 / WCAG 2.0 Compliant: □ yes □ no
Comments / Recommendations / Accommodations Necessary:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Student Privacy / FERPA Compliant: Compliant: □ yes □ no
Comments / Recommendations
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Legal Compliance: □ yes □ no
Comments / Recommendations
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Instructional Technologies Task Force Approval: ____________________________________ Date: _________________
Technology Committee Approval: _______________________________________________ Date:_________________
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Cuesta College - ITTF Request Form

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Completed 30 May 2020

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