Latest Equipment Added as of October 12, 2011:
Application
Please verify the Item Control Number
* Item Control Number:
School Information
* School Name:
* Department Name:
* Department Head Name:
Applicant's Information
* First Name: Middle Init.: * Last Name:
* Address:
Address 2:
Building:
* City: * State: * Zip:
* Telephone Number: (###) ###-####
Fax Number: (###) ###-####
* E-mail Address:
* The free shipping to "high needs" schools program has been discontinued until further notice, due to budget constraints. We apologize for any inconvenience that this change may cause.
* Method of Shipment:
Account Number:
Purchase Order:
* Shipping Address:
* City, State, & Zip:
* Description of how equipment will be used:
* Description of any equipment granted by the ERLE Program in the last 3 years:
* Do you agree with the following Department's Certifications
ERLE Guidelines No Yes
Drug-Free Certification No Yes