63-11-53-A
Rev. 01/14
Request For New Technology Approval:
Installed Software, Projects, Student Technology Assistant Programs
Santa Rosa County District Schools
Note: This form is not required for previously approved software. Please check
https://www.santarosa.k12.fl.us/pdc/docs/dtp/adden07a.pdf for previously approved software.
This section is to be completed by the teacher/administrator making the request in cooperation with the Tech Contact. If student or
teacher data will be entered into the software program and the vendor will have access (for instance, to remotely troubleshoot),
please obtain a Confidentiality Disclosure Agreement, first.
Per Florida Statute 1006.281, districts are required to provide single sign‐on access to all district resources. Is this program Active
Directory compliant (LDAP or SAML)? Yes No (circle one)
School:
Date:
Name:
Room #:
Name and description of proposed software, technology project or special program (please attach any supporting materials).
Rationale for implementation or use:
Applicable standards:
If this is a project/program proposal, detail the type of support the school will provide and/or expects from the district.
If this program involves students, what type of security measures will be in place (e.g., student contracts, supervision, and
computer access management)?
Technology Contact’s Signature of approval:
Site Administrator’s Signature of approval:
 Please send this form and all materials associated with this software/project to Eric Englert at the
Professional Development Center for processing.
This section is to be completed by Director of Instructional Technology and Data Processing Manager or designees.
Permission: _____Granted _____Denied
Student Contract Required (circle) Yes / No
Details/Restrictions/Explanations:
DP Signature
Title:
Date:
PDC Signature:
Title:
Date:
**If approval is granted, maintain original in the school’s Technology Notebook (with copy of license if request was for new software).
Revised December, 2013
63-11-53-A
Rev. 01/14
Request For New Technology Approval:
Installed Software, Projects, Student Technology Assistant Programs
Santa Rosa County District Schools
Follow-up For Site-based Testing of Software/Technology Project/Special Program
Software/Project/Special Program test was a
Success _____ Failure _____
Briefly describe the outcome of the test.
Briefly describe the results and conclusions that led to the success or failure.
Name of person over-seeing project: ________________________________ Date: ___________
** Please send this follow-up form via courier or email to the Professional Development Center upon completion of test.
This section is to be completed by Director of Instructional Technology or and Data Processing Manager or designees.
Based on the success or failure of the project or software to meet district needs and requirements,
Permission is _____Granted
_____Denied for continued implementation of the software, project, special program.
Details/Restrictions/Explanations:
DP Signature
Title:
Date:
PDC Signature:
Title:
Date:
**If approval is granted, maintain original in the school’s Technology Notebook (with copy of license if request was for new software).
Revised December, 2013