CTE Request for Equipment Funding (REF) Form 2021-22
(Eligible CTE Teacher must teach 50% of bell schedule in CTE approved courses)
School Name:
Cost Center:
Sector:
GL Acct Total Requested Cost
440001
440001 HW
Vendor Name
Quotes from LAUSD registered vendors
required at this time for this category
640001
Vendor Name
Quotes from LAUSD registered vendors
required at this time for this category
I verify that my pathway satisfies the following conditions: (check all that apply)
no student capstone enrollment without a concentrator completion
instruct at least 50% of my school's bell schedule in CTE
I am a middle school CTE pathway
CTE Teacher Name CTE Teacher Signature
Date
Principal Name Principal Signature
Date
Category
NON-CAPITAL EQUIPMENT
Pathway Specific Non-Capital Equipment (unit cost > $500)
Include computer hardware requests here (Arey Jones or Apple only)
Grand Total Amount Requested
The approved equipment may NOT be substituted. Keep all documentation for a possible audit review in a CTE binder.
Funding form and supporting quotes are due to Samantha Donn via email at samantha.donn@lausd.net by 5:00 p.m. on Friday September 10, 2021.
Forms without required signatures, quotes or capital outlay forms will not be reviewed or awarded. Contact Samantha Donn if you have questions.
I will provide evidence of completed CTE student project(s) using requested equipment showcased in CTE student Portfolium account by
May, 2022.
Pathway Specific Capital Equipment (unit cost > $5,000) including sales tax & shipping
charges
CDE’s Capital Outlay Request for Pre-Approval and Administrative Assurances forms must be
submitted for each proposed capital expenditure.
640001 Subtotal
CAPITAL EQUIPMENT
Name of CTE Teacher:
Pathway:
CTE Teacher Employee #:
click to sign
signature
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click to sign
signature
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