Request for Equipment Purchase Approval Form > $5K+ - DOC by yRP28V


									                     Request for Public School Equipment Purchase Approval Form > $5K+

                                      Individuals with Disabilities Education Act

To:       Mr. Francis Chang
          Business Operations Specialist, Special Education Bureau
          New Mexico Public Education Department
          Phone: (505) 827-1459 Fax: (505) 954-0001

From (LEA):

LEA Contact Name:

Phone:                                                  Fax:

   The LEA must expend the funds as indicated in the substantially approvable IDEA-B sub-grant
     application and in accordance with State and Federal laws. If you have questions about what is allowable,
     see OMB Circular No. A–87, Attachment B, Selected Items of Cost Number 15. The Circular can be
     located at
   An LEA can purchase or lease equipment with IDEA funds, if
         o It is reasonable and necessary to operate its federal program effectively,
         o Existing equipment will not be sufficient, and
         o Costs are reasonable.
   The LEA is required to manage the property (equipment) using the procedures that meet 34 CFR § 80.32
     which includes, but is not limited to, a fixed asset inventory, annual physical inventory, control system,
     maintenance procedures, and procedures to sell equipment.
   Before purchasing equipment, please complete this form (as applicable) and return via fax. The form will
     be sent back to you, if approved. Do not purchase the equipment until you have received written

    * Fund Codes include: 24106, 24109, and 24112 (if Coordinated Early Intervening Services approved)
 Item Description              Quantity Unit Price         Total Cost      Fund Code      Function Code

Equipment purchased for a specific student:
         Equipment is identified in the student’s IEP dated (IEP must be current):

         Equipment will/will not (circle one) require upgrading or replacement before the student exits school.
         If an upgrade or replacement is required, how will this be achieved, including funding?
         How will the equipment be maintained? ___________________________________________________
         For assistive technology equipment, technical assistance consultation was provided by:
                                      (agency or company familiar with assistive technology (AT) for persons with
         Describe the LEA’s process for property management as required under 34 CFR § 80.32: ____________

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Equipment Purchase – Public Schools
June 2011
Equipment purchased for general special education student support:
        Equipment supports #                            students who receive special education services. Attach the
         list of student identification numbers this equipment will support.
        Where will the equipment be located:
        Equipment will require upgrading, maintenance or replacement Yes / No (circle one).       If Yes:
             o    How will it be maintained?
             o    How will this maintenance be funded?
             o    What is the expected annual support cost?
             o    What is the expected life cycle of this equipment?
To be completed by the Special Education Bureau Staff

_____    Equipment purchase included in substantially approvable sub-grant application

_____    Funds for the equipment approved in the Operating Budget Management System

_____    District submitted all required documentation

Special Education Bureau Approval                                                                             Date

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Equipment Purchase – Public Schools
June 2011

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