Mississippi Department of Education
TECHNOLOGY PURCHASE REQUEST
DATE
TO: DEPARTMENT OF EDUCATION REQUESTOR
OFFICE OF TECHNOLOGY & STRATEGIC SERVICES NAME
TITLE
PHONE
OFFICE
DESCRIPTION:
Provide a brief hardware/software description and quantities needed.
JUSTIFICATION:
Provide detail information to justify the purchase requested.
BUDGET CODES:
Provide funding codes and certify there is adequate budget authority to make this purchase.
Budget Year:
(Funds Certification- Signature)
Fund:
Cost-Center:
Internal Order:
SIGNATURE/TITLE DATE
Department Director
FOR OFFICE OF TECHNOLOGY AND STRATEGIC SERVICES USE ONLY
REVIEWED BY DISAPPROVED
APPROVED BY DATE