Please fill out the following application to request a Refurbished Computer System (RCS). The Refurbished Computer Program is sponsored by the PATINS Project.
1. Applicant's Work Information (Required) The applicant is usually the Teacher of Record.
Name
County Code-Corporation or District Code- School
[Example 84-8435-3309]
County Name
Corporation or District Name
School Name
If you need assistance in finding your school code, you can look it up at the DOE web page. Just click on the highlighted link,
http://www.doe.state.in.us/publications/schooldirectory.html or copy and paste the following link into your browser: http://www.doe.state.in.us/publications/schooldirectory.html)
2. Applicants Work Address Information (Required)
Street
City/Town
Zip Code
Telephone
Fax
Email
3. Applicants PATINS Regional Site (Northwest, Northeast, Central, Southwest, Southeast)
(If you need assistance in determining which PATINS Regional Site supports you, please check the State Map .
4. Which describes the setting under which the RCS is going to be used .
(Preschool, Elementary, Middle School, High School, Home Use)
5. Complete if Computer is for Home Use: (must provide the name of the family member and address where the computer will reside; parent will need to sign
Recipient Name (Student & Parent)
Address
City
State
Zip
Telephone
Fax
Email
6. Please list the minimum hardware requirements for the software you intend to install on this computer. (Required) NOTE: Read your software documentation for the hardware requirements.
Computer Type
Processor Speed
Random Access Memory
Monitor Size
Modem
Network Card
(PATINS will attempt to provide you with your minimum system requirements. However, note that we can not guarantee the provision of a modem, specified monitor size or mouse type.)
Example:
Computer Type: Desktop, Laptop
Processor Speed: 800 Mhz
Random Access Memory: 128 mb
Monitor Size: 15"
Modem: Yes, internal 56 Kbps (Most classrooms do not have telephone connections, good for Home Use if the home does not have High Speed connection)
Network Card: Yes (Only needed if you have a network or use High Speed connections (Ethernet)
Notice:
●PATINS Project provides computer systems and equipment "as is".
●PATINS Project, equipment manufacturers and Microsoft provide no follow-up support, technical assistance or upgrades for these systems, software or equipment.
●The computer(s) is provided with a Microsoft operating system only, either Windows 2000 or XP Pro.
●The current Open Office Suite will be installed.
.
●Applicant or Contact Person is required to READ the Microsoft Refurbisher Agreement (MAR) Recipient Agreement Form before turning the computer on.
Date of this application request
Name of person completing this request.
Also, please add any comments in this field.