Fillable Tech Fee Form Louisiana State University - Eunice

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Tech Fee Form Louisiana State University - Eunice

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Louisiana State University Eunice
Request for Student Technology Fee Project Funds
Project Summary
T
itle of Project: __________________________________________________________________
D
ivision: _______________________________ Contact Person: __________________________
W
hat is the potential number of students this project will serve the first year: __________________
Summary of Project (DO NOT EXCEED 250 WORDS)*
(The following items should be included in your summary: A general overview of the program along with how
it will be implemented, a description of the population that this project will serve now and in the future, the
direct benefits students will receive from this project, how this program will improve the service currently
provided to our students, and any negative aspects that may result if this program is not funded.)
Signature of Department Head: ____________________________________ Date: ____________
S
ignature of Project Contact: _______________________________________ Date: ____________
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Louisiana State University Eunice
Request for Student Technology Fee Project Funds
Budget Summary
Title of Proposal: _______________________________________________________________
Division: _______________________ Contact: ______________________________________
I. PROPOSED BUDGET:
Student Tech Fee Funding from other Total Requested
A. Equipment
Money Requested
B. Software
C. Supplies
D. Shipping/Handling
E. Installation
F. Other Expenses (Identify)
1.
2.
3.
4.
5.
Sources
G. Total Costs
(A through F)
Detailed Budget Request Page: _________
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Yes
Yes
Yes
No
No
No
Detailed Budget Request Page: _________
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Yes
Yes
Yes
No
No
No
Detailed Budget Request Page: _________
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Yes
Yes
Yes
No
No
No
Detailed Budget Request Page: _________
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Yes
Yes
Yes
No
No
No
Detailed Budget Request Page: _________
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Item:
Qty
: __________ Price/each: _____________ Total Price: _____________
Is there a recurring cost associated with this item? If so, how much? ___________
Detailed item description:
Yes
Yes
Yes
No
No
No
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Tech Fee Form Louisiana State University - Eunice

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Completed 2 July 2020

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