Fillable Instructional Equipment Request Form2016 2017 Fillable (Las Positas College)

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Instructional Equipment Request Form2016 2017 Fillable (Las Positas College)

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INSTRUCTIONAL EQUIPMENT (IE) REQUEST: 2016-2017
THE FOLLOWING INFORMATION WILL CONTRIBUTE TOWARD A QUALITY IE REQUEST
Consult the RAC Web Site for Deadlines for IERs
IE Definition
Allowable Items: Instructional equipment expenditures are eligible if the equipment, library material, or technology is for
classroom instruction, student instruction or demonstration, or in the preparation of learning materials in an instructional program.
There are five categories that will be used to classify instructional support. The following are examples but the list is not limited to
what is shown.
1. Equipment and Furniture: instructional equipment and furniture for primary use by students in instructional programs:
a. Classroom/Laboratory equipment, including whiteboard, screen, projector, etc.
b. Instructional furniture, including desks, tables, podium, chairs, etc.
2. Information Technology: instructional information technology equipment for student use in classrooms and/or laboratories,
including desktops, laptops, monitors, printers, servers, network/wireless infrastructure, AV/TV, multimedia.
3. Software: software licenses are allowed but only the initial year is permitted. Other software that are permitted are those that
are used in excess of one year and software modifications that add capacity or efficiency to the software that defers
obsolescence and results in an extension of the useful life of the software, including registration, counseling, student services,
learning management systems for student use.
4. Adaptive Equipment: adaptive equipment for ADA/OCR students are allowed to assist them in a learning environment.
5. Library Material: databases, on-line subscriptions, books, periodicals, videos, etc.
Non-Allowable Items: Administrative or Non-Instructional Purposes including equipment being used for administrative or non-
instructional purposes is not allowed including photocopiers, file cabinets, bookcases, computers, networking infrastructure,
software licenses.
IE Checklist Completed
Completed
Section 1: Summary Information __________ Section 7: Total Cost of Ownership __________
Section 2: Equipment Description __________ Part A: Initial Start-up Costs __________
Section 3: Mission & Priorities __________ Part B: On-Going Annual Operating Costs __________
Section 4: Educational Items __________ Part C: Incremental Labor Costs __________
Section 5: Teaching and Learning __________ Quotation Attached, includes: __________
Section 6: Outcomes __________ ☐ Tax (9.5%) __________
Section 7: Cost of Ownership __________ ☐ Shipping __________
Section 6: Outcomes __________ ☐ Installation __________
Requisition Attached (signed by Dean and VP)
IE Rubric
RAC will
evaluate each IE
request based on
the IE rubric.
RAC stresses the
importance of
quality requests.
RAC may choose
not to rank
incomplete IE
requests.
8/17/16
1
Internal Use
IE #: _______________
Total $:_____________
INSTRUCTIONAL EQUIPMENT REQUEST
2016-2017
Requester Name: ________________________Division Name: ________________________
SECTION 1: SUMMARY INFORMATION_______________________________________
Brief Title of the Request:
Equipment Location Building: ____________________ Room: ______________________________
SECTION 2: EQUIPMENT DESCRIPTION______________________________________
The equipment is: ☐ A Replacement ☐ An Upgrade ☐ New Equipment/Technology
Describe the specific equipment requested and how it will be used to replace, upgrade or provide new
technology to LPC from what is currently in place:
If applicable, describe the legal requirement, mandate, or safety concern for purchase of this equipment,
making specific reference to the legal requirement or regulation:
2
LPC MISSION STATEMENT:
LPC is an inclusive learning-
centered institution providing
educational opportunities and
support for completion of students’
transfer, degree, basic skills,
career-technical, and retraining
goals.
LPC PLANNING PRIORITIES:
Establish regular and ongoing processes to implement best practices
to meet ACCJC standards.
Provide necessary institutional support for curriculum development
and maintenance.
Develop processes to facilitate ongoing meaningful assessment of
SLOs and integrate assessment of SLOs into college processes.
Expand tutoring services to meet demand and support student
success in Basic Skills, CTE, and Transfer courses.
SECTION 3: LPC MISSION STATEMENT AND LPC PLANNING PRIORITIES______
Specify how the equipment supports LPC’s Mission Statement and Planning Priorities:
SECTION 4: EDUCATIONAL ITEMS – PROGRAM REVIEW______________________
Specify the educational programs this equipment supports:
If this equipment is included in your Program Review, please include the exact wording. If equipment is
not included, explain why:
SECTION 5: TEACHING AND LEARNING______________________________________
Describe in detail the impact this equipment will have on teaching:
Describe in detail the impact this equipment will have on learning:
Each academic year, this equipment will impact: ____ # of classes/sections ____ # of students
3
SECTION 6: OUTCOMES (SLOs)_______________________________________________
Using your documented SLOs, specify how the equipment will enable student learning outcomes to be
achieved?
What are the consequences related to learning outcomes if request is not funded?
SECTION 7: TOTAL COST OF OWNERSHIP (FINANCIAL & SUSTAINABILITY____
What is the potential life span of the requested equipment?
If new storage is needed, describe the storage, location, and costs: (Specific storage costs should be
detailed in the “Part A: Initial Start-up Costs” section below.)
What will be required to maintain the equipment, such as regular servicing or upkeep? (Specific on-going
costs should be detailed in the “Part B: On-Going Annual Operating Costs” sections below as applicable.)
Explain how this equipment meets or exceeds basic sustainability efforts and/or provides renewable
resources to the college:
4
Part A: Initial Start-up Costs
Item
Cost
Comments
Equipment or Materials
Taxes (9.5%)
Shipping or Delivery Charge
Installation Costs *
Miscellaneous Costs:
Facilities Modifications
Operator Training
Maintenance & Repair Training
Other: ______________________
Vendor Discount
Part B: On-Going Annual Operating Costs
Item
Cost
Comments
Annual Service or Maintenance
Estimated Parts Replacement Per Year
Outside Standardization or Calibration
Costs
Storage Costs
New Supply Costs
Miscellaneous Costs:
Maintenance & Repair Labor
Other: ______________________
Indicate the source of funding for on-going annual operating costs:
5
Part C: Incremental Labor Costs
OPERATOR:
Indicate the key operator: ___________________________________________________________________
Is this in their current scope of duties? _________________________________________________________
Indicate cost to train key operator (include in Initial Start-up Costs above): _________________________
Indicate amount of time per month key operator will use equipment: _______________________________
MAINTENANCE & REPAIRS:
Indicate the person performing maintenance and repairs: ________________________________________
Is this in their current scope of duties? ________________________________________________________
Indicate cost to train for maintenance and repairs: ______________________________________________
Indicate amount of time per month maintenance will be required: _________________________________
SECTION 8: APPROVALS____________________________________________________
Funded requesters will be expected to respond to a brief RAC feedback survey by a requested deadline.
Requests for computer-related equipment and printers must be reviewed by the LPC IT Department.
Signatures:
______________________________________ ________________________________
Requester Date
______________________________________ ________________________________
IT Department (if required) Date
______________________________________ ________________________________
Dean/Manager Date
______________________________________ ________________________________
Vice President Date
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Completed 21 July 2020

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