Request for Instructional Equipment (Block Grant) Funds 2004-05

Please complete a separate form for every equipment item you are requesting!

Department: _______________________________________________

Discipline: _______________________________________________

(one or several)

Description of equipment (as it appears on the Departmental Summary Form):

_______________________________________________________________________

DEPARTMENTAL PRIORITY # ____

Check the college goal that will be supported by your request:

Educational programs and services will be developed, evaluated, and improved to ensure student access, learning and success while maintaining appropriate academic standards.

Human physical, technological and financial resources will be managed effectively to enrich and expand

Educational programs and maintain fiscal stability.

Relationships with the community at large will be enhanced to promote common development.

Quantity: ________________

Total Price: _________________

Describe below (in one or two paragraphs) how the requested equipment will enhance the goals of the college,

department, discipline, program and/or service area.

Department Chair’s Signature: _______________________ Date: _______________