Alief ISD Request for IMA Expenditure – revised form Oct. 2013

For Campus: / Content Area:
Title & Description: / Material requirements:
Additional materials to some currently in use?
Replacing existing materials?
First-time materials for a NEW course?
Will theseinstructional
or technology materials
be used: → /
  • as class sets Yes No
  • intended as one per student Yes No
  • or other distribution?

Is this a one-time request, or will more be needed later (additional sections or recurring costs in subsequent years)?
Additional Comments: / Implementation date?
Title / Edition & Copyright Year
(2nd, 8th, etc.)
ISBN (Textbook - preferably 13-digit when possible) / Total dollar amount for this request
including shipping
Author / # Students Served
Grade(s) / TEKS % / Vendor/Publisher Name to purchase from:
Course Name
Course Number
PEIMS Number / Quantity
student
edition
Price per each item? / Quantity
teacher
edition
Price per each item? / Quantity
Other
Price per each item?
↓Media Format – Please select all that apply ↓
EMAT 0 None / EMAT 5 Electronic – Non-interactive CD-ROM
EMAT 1 Print with Video/DVD / EMAT 6 Electronic – Non-interactive Video/DVD
EMAT 2 Primarily Print / EMAT 7 Electronic – Interactive Video
EMAT 3 Print w/ Online Access / EMAT 8 Electronic – Interactive Online
EMAT 4 Electronic–Non-interactive Online
Publisher / Free Materials
(included w/purchase)
Teacher Materials
(included w/purchase) / Describe any other additional materials provided with purchase:
Purchasing compliance to buy from this source:
  • Sole Source Letter:
Yes, attached OR No, not Needed
(if publisher is seller, Sole Source is implied)
  • AliefISD RFP(if applicable)
  • Co-Op(if known)
/ Language English Spanish Other
Shipping Costor indicate if free shipping
Quote attached including Total Dollar Amount
with Shipping Charges (if any) Yes No
↓ Subject – click in the gray area, then select one from drop down menu box ↓
"select subject"CTE EMH CAREER & TECH EDELAR E ENG LANG ARTS & READING GR K-5ELAR M ENG LANG ARTS & READ GR 6-8ELPS EMH ENG LANG PROFICIENCY STANDARDSENGLIGH H ENG GR 9-12ESL EM ENG AS A SEC LANG K-8ESOL H ENG SPEAKERS OTHER LANG HSFINE ARTS EM FINE ARTS GR K-8FINE ARTS H FINE ARTSHANDWRITING HANDWRITING GR K-4HEALTH EMH HEALTHLOTE EMH LANG OTHER THAN ENGMATH EM MATH GR K-8MATH H MATHEMATICSPRE K PRE-K MATERIALSSCIENCE EMH SCIENCESOC STUD EM SOC STUDIES GR K-8SOC STUD H SOC STUDIES & HISTORYSPELLING GR 1-6TECH APP EMH TECH APPLICATIONS
Distribution Instructions upon Receipt
Send to Campus: / Number of
Student Editions: / Number of
Teacher Editions:
Requestor printed name and signature / Date
The following section completed by Content Coordinator
If applicable, completed/signed Database Software Form(s) attached
Yes No / Can existing “district” materials be redistributed to satisfy this request?
Yes No
Anticipated lifespan of materials? / Additional Comments:
Have Bilingual Materials been accounted for?
Yes No Comments: / Have Special Ed Materials been accounted for?
Yes No Comments:
Can Federal Funds be used to obtain these items?
Yes No Comments: / Has Assistive Technology been considered?
Yes No Comments:
Coordinator name: / Approval signature: (also requires technology approval if electronic) / Date:
Final Approvals
ADMINISTRATION
APPROVAL / Deputy Superintendent Instruction / Signature / Date:
Deputy Superintendent
Business / Signature / Date:

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