E-rate Technology Plan Annual Review/Update Certification by sa6662B


									                                OFFICE OF SUPERINTENDENT OF PUBLIC INSTRUCTION
                                              Educational Technology
                                                Old Capitol Building
                                      PO Box 47200, Olympia, WA 98504-7200

                                             Intent to File
                                2013-2016 District Technology Plan

    Districts applying the E-rate discount on Priority 2 eligible services.
    Districts applying for the E-rate discount on Priority 1 telecom and network equipment/services
      that want a state-approved tech plan on file.

Keep a file copy and mail this form to OSPI postmarked no later than Thursday, November 15, 2012:
        Julia Fallon, Educational Technology, OSPI
        PO Box 47200
        600 Washington Street SE
        Olympia, WA 98504-7200

The                                                                              School District
intends to submit a technology plan for 2013-2016.
Check one or both.              Priority 1             Priority 2

Complete & Sign
We will use the contact information below to keep you informed on developments related to the new
tech planning process.

                       Name (printed)

             Superintendent Signature

                       Name (printed)

District Technology Director Signature


                       Contact Name

                        Contact Email

                       Contact Phone

FORM SPI 1685 (9/12)

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