Software Purchase Request

To request purchase of software, please complete the following form. The Information Technology Department will review your request, existing licensing, and contact you if additional information is needed. Once the purchased software is received, we will contact you to complete the Software Installation Request form.

First Name: *

Last Name: *

LCC Email: *

Phone: *

Department/Division: *

Department/Division Dean: *

Software Title: *

Manufacturer: *

Platform: *

Mac

Other

Other:

Please give details about the computer (Manufacturer, Model#, amount of RAM, size of hard drive, OS).

Minimum Hardware Requirements: *

Vendor: *

Price per License: * $

Number of Licenses Required: *

Degree Program: *

Course Name: *

Skills and Competencies Addressed: *

Does this replace an existing application?: *

Yes

Please Explain:

Program Advisory Committee Recommendations: *

Total Amount: * $

FOAP to Charge: *

Date Required for Installation: *

Month

Day

Year

Leave this field blank