1. If you recently received a form with a Priority Code, please enter the code here. 2. In lieu of a signature, we require a personal identifier. To verify that you submitted this subscription request, please enter the month in which you were born. *3. First Name *4. Last Name *5. Title *6. Organization *7. Organization Address (street address, city, state, zip) *8. Telephone (with area code) 9. E-mail address 10. Do you recommend, evaluate, specify or approve technology purchases for educational institutions? 11. What best classifies your job description? Select Answer US/Regional/State Department District Office High School/Secondary School Middle/Junior High School Elementary Kindergarten Other K-12 Other 12. What is your job title/function? Select Answer Regional/State Technology Director/Coordinator District Technology Director/Coordinator School Technology Director/Coordinator US Department of Education Staff Member State Department of Education Staff Member District MIS Director Superintendent/Assistant Superintendent Principal/Vice Principal Federal/State Program Administrator Department/Area Chairperson Librarian/Learning Resource Specialist Curriculum Director Media/AV Specialist School Board Member MIS/IT Manager/Director/Head Business Officer Technology Buying Educator/Consultant Technology/IT Support Specialist Other 13. Which of the following products, services and/or technologies do you plan, approve, specify, recommend, purchase or influence? 14. What is the enrollment level for which you purchase, specify, recommend or approve the puchase of IT products and/or services? Select Answer More than 5,000 2,500 - 4,900 2,000 - 2,499 1,500 - 1,999 1,000 - 1,499 500 - 999 100 - 499 Less than 100 15. Please select your top two suppliers of computer technology products and services.
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