Electronic and Information Technology (E&IT) Procurement Request
Form ITS-4801 Rev N 1-28-15 Page 1 of 3
Executive Order 926 (EO 926: January 1, 2005) mandates CSU campuses to make its programs, services and activities accessible to students, faculty, staff and the general public who visit or attend a campus-sponsored event, with disabilities. Section 508 of the Rehabilitation Act of 1973 requires the
University to apply accessibility standards to all electronic and information technology products and services that it buys, creates, uses and maintains.
Electronic and Information Technology is defined as any product or service that stores, records, transmits, presents or conveys information.
This form must be completed, approved and attached to all technology-related requisitions, including hardware, software, hardware and software maintenance, software renewals and subscriptions, and hosted services.
Colleges and departments, in coordination with their ITCs, are responsible for ensuring that the E&IT analysis has been completed and the product or service meets all accessibility requirements, and that the requisition package is complete before submitting for review .
Procurement and Contracts will return incomplete requisition packages to the requestor.
The following are excluded from the procurement approval process: computer supplies, such as CDs, ribbons, stock paper, etc.; computer monitors and displays; wireless presenters; wired and wireless keyboards; wired and wireless mouse; wired and wireless desktop speakers; video cards and video adapters; cables, except network patch cables; USB hubs; UPS battery backup for desktop; digital cameras, camera lenses and other camera accessories; facsimile machines; televisions; smartphones; apps for individual use; and disks, SD cards, electronic and data storage devices.
Departments are responsible for securing Level 1 and 2 confidential data on all devices, including those excluded from this approval process.
1. Prepare the campus Purchase Requisition and include the requisition number (Req ID) on all forms submitted in the Requisition Package.
2. Complete the online E&IT accessibility analysis at http://www.calstatela.edu/accessibility/ati/eit-procurement . Attach the completed analysis to the E&IT Requisition Package.
3. Prepare the Requisition Package as outlined below.
4. Submit the completed and approved electronic and information technology requisition packages to the ITS Help Desk (LIB PW Lobby).
The requisition package must include all of the following that apply:

Purchase Requisition (required)

Accessibility Analysis (required)

ITS-4801 E&IT Procurement Request (this form; required)
Plus the forms associated with one of the following two options:
Option A – The requisition has more than 10 users and has been evaluated for accessibility, or the requisition is a product used as a required part of an academic curriculum.

Voluntary Product Accessibility Template (VPAT), available at http://www.calstatela.edu/accessibility/ati/eit-procurement-vpat-repository .

Also, if necessary, form ITS-4822, Equally Effective Alternate Access Plan (EEAAP) at http://www.calstatela.edu/its/services.php
. Click on
Procurement  Forms.
Option B – An exemption from accessibility requirements is being requested.

Complete form ITS-4821 E&IT Exemption Request at http://www.calstatela.edu/its/services.php
. Click on Procurement  Forms.
Contact Name:
Department:
Approving Dean/Manager (print or type) :
Contact Email Address:
College/Division:
Dean/Manager Signature:
Office Location/Phone:
/
Mail Code:
Date:
ITC Name (print or type) :
ITC Signature: Date:
Requisition # (Req ID): (# assigned by the online purchasing system)
Note: The requisition number must be included on each form in the Purchase Requisition package.
Is this a requisition renewal? Yes No
If yes, original PO number, if known: Original PO date, if known:

Electronic and Information Technology (E&IT) Procurement Request
Page 2 of 3 Form ITS-4801 Rev N 1-28-15
This field is mandatory.
Incomplete forms will be returned to the requestor.
Number of software installations:
If customized, what is the justification for this software?
Describe the software support plan(s):
Number of licenses being purchased:
Number of mobile app users: Number of app licenses being purchased:
Is this a functional app? (For a role or job function) Yes No
Is this an instructional app? (For course work) Yes No
Describe the functional or instructional purpose:
Is software customized (e.g., non-standard)?
Yes No
Is the app customized (e.g., non-standard)?
Yes No
Check one: Computer Server Laptop iPad or Tablet
Network Switch Router Ethernet Hub
Wireless Access Point Wireless Router Wireless Bridge Wireless Gateway Network Patch Cables
Multi-function Device (MFD) Printer Copier Multi-media equipment
Other:
Describe the hardware support plan(s):
Check one: Information Technology-based Hosted Service If selected, also check one of the boxes below.
Software as a Service (SaaS) Infrastructure as a Service (IaaS) Platform as a Service (PaaS)
IT Contracted Service
Data Storage Service
Will Levels 1 and 2 confidential data be stored on the above computer/device or at the above hosted service?
Yes No
If yes, describe the confidential data that will be stored:
If yes, identify who will be responsible for encrypting the confidential data:
If yes, identify the individual who maintains the backup copy of the data in the event this device is lost or stolen and unencrypted confidential data is acquired or reasonably believe to have acquired by unauthorized individuals:
If a hosted service, h ave you attached vendor documentation that specifically describes the vendor’s security measures for the transmission to and from the service, and while at rest? Yes No

Electronic and Information Technology (E&IT) Procurement Request
Page 3 of 3 Form ITS-4801 Rev N 1-28-15
Has the vendor provided a signed copy of form ITS-2808 Information Confidentiality and Non-disclosure Agreement ?
Yes No
By signing this form, I affirm that the requestor or designee has performed a complete and thorough Electronic and Information
Technology (E&IT) Accessibility Analysis, as required. I have determined that acquisition of the applicable E&IT product(s) or service(s) required by my department is/are is not/are not subject to Section 508 of the Rehabilitation Act of 1973, and codified in California Government Code 11135.
Dean/Manager Name (type or print) :
Dean/Manager Signature of Approval
Date
ITS Review and Approval:
(Check the appropriate box and sign or initial after receiving and approving this procurement request. Include any comments or conditions that may apply to this procurement)
Signature _______________________________________________________ Date ________________________________
Comments:
Enterprise Applications IT Infrastructure Services IT Security and Compliance
VP ITS and CTO Review and Approval:
Signature _______________________________________________________ Date ________________________________
Procurement Review and Approval:
Signature _______________________________________________________ Date ________________________________