iPad App Confirmation Form

	Mobile devices are available on a limited basis allowing teachers the opportunity to try a new technology in the classroom. This program is not intended to supplant district purchase of instructional equipment.

	By booking this item you agree to the Authorized Use Policy for the use of this device, the device MUST remain in the classroom and/or school building with adult supervision.

	Please follow your district policy for borrowing mobile devices!

	Due to high demand, Monroe 1 BOCES reserves the right to decline bookings.

1.	Your Name*

2.	Start date of device booking*
	mm/dd/yyyy

3.	Your email*

4.	Your District*

5.	Your Building*

6.	Your grade level or department*

	Please view this file: List of pre-loaded apps

7.	Pre-loaded apps*
	Pre-loaded apps* Elementary Level Middle/High School Level No pre-loaded apps, only load apps listed below (up to 5)

8.	Please indicate how you intend to use iPads for instruction. *

9.	Are iPads currently available for loan within your school? *
	--Please Select--YesNo

10.	Are mobile devices currently available within your classroom?*
	--Please Select--YesNo

11.	If you would like to try any additional FREE educational apps (up to 5), please list, USING COMMAS between app names.

12.	Additional information or comments:

	Please click "Done" to submit this form.