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									                                   JCPS Application for Cellular Phone Service

Name (person to use phone)______________________________________

Cost Center (School)____________________________________________

Cost Center Address____________________________________________________ Cost Center #_____________

Rationale for need of cellular service (use reverse side if more space is needed)

Cellular Service                                                                         monthly service (CIRCLE ONE)
Analog Service                                                                                         $0 & 20¢ per minute
Digital/Analog Service                                                   (a) $14.95 w/75 minutes & 20¢ per minute thereafter
  (a or b: when digital is unavailable, analog service will pick up)     (b) $25.00 w/250 minutes & 25¢ per minute thereafter

Voice Mail (Basic VM, with enhanced calling features & call detail)                                       included at no charge
Long Distance Charge                                                                                             14¢ per minute
  Long distance calls made from local calling area to anywhere in KY -- no charge. Roaming and long distance
  outside local calling area are subject to higher per minute charge and higher long distance charges.

Phone(s) Purchase                                                                # ofitems                   purchaseprice
Portable Phone: NEC 920, Nokia 918, Motorola 650 (analog)                                                             $69.00
Flip Phone: LGC 330, Qualcomm 860 (digital & analog)                                                                    $149.00

Extra Battery - Portable Phone                                                                                            $39.95
Extra Battery - Flip Phone                                                                                                $79.95
Mobile Adapter (Cigarette Lighter Adapter)                                                                                $25.00
                                           (note: a billing statement will be sent monthly)

I agree that the above is accurate, understand that all costs of service will be borne by the cost center listed above, and
that I will follow the JCPS “Cellular Phone Guidelines”.

Signature________________________________ Signature of Cost Center Head__________________________________

Name (please print)____________________________Name of Cost Center Head (please print)______________________

************************************************** Office use only *******************************************************
Approved by: _______________________________________

 Title _______________________________________________

 Date ordered ____________________________                             Cellular Phone number _________________________
 (revised 8/14/00)
  After approval is received, create an on-line Purchase Order, attach a copy to this form, and send to the Telecommunications Unit.

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