Contact Information (Applicant)

1. Name*:
2. School District*:
3. Title*:
4. Street*:
5.  
6. City*:
7. State*:
8. Zip*:
9. Email address*:
10. Telephone*:
11. Website:

School Information

1. School Type*:
2. # of Students*:
3. # of Classrooms*:
4. % of E.L.L Students*:
5. # of Free / Reduced Lunch*:

District Information

1. # of Students*:
2. % of E.L.L Students*:
3. # of Free / Reduced Lunch*:

Current Classroom Technology Found In Your School(Check all that Apply. If "yes" for specified components, enter all additional information.)

1. Component % of Rooms (approx.) Makes/Models


2. Projector:
3. Television:
4. Interactive White Board:
5. Teacher Computer: -- Select OS -- Windows Mac OS X Linux Other Mixed
6. Amplifier/Speakers:
7. DVD Player or VCR:
8. Wireless Microphone:
9. Document Camera:
10. CATV Tuner:
11. iPod / Podcasting:
12. Wireless Ethernet:
13. Other:

Current Classroom Technology Found In District(Check all that Apply)

1. Component % of Rooms (approx.) Makes/Models


2. Projector:
3. Television:
4. Interactive White Board:
5. Teacher Computer : -- Select OS -- Windows Mac OS X Linux Other Mixed
6. Amplifier/Speakers:
7. DVD Player or VCR:
8. Wireless Microphone:
9. Document Camera:
10. CATV Tuner:
11. iPod / Podcasting:
12. Wireless Ethernet:
13. Other:

Please describe how you think a classroom voice amplification system grant will benefit your school and be sure to list any specific challenges a voice amplification system will help solve*.

Please describe the general plan for adding educational technology to classrooms in your school/district over the next five years*.

Calypso Systems wants to ensure our classroom voice amplification system is compatible with your exisiting classroom instructional technology. Please list any educational A/V technology planned to be installed in the 2011-2012 school year*.

If available, please list any technology consultants that your school district uses when considering a classroom technology purchase (e.g., IT consultant, architect, electrical engineer).

1. Consultant Name:
2. Company Name:
3. Phone:

1. Consultant Name:
2. Company Name:
3. Phone:

Check one of the following*:

1. I am a technology administrator for the school and/or district
2. I have received the approval of the following technology administrator for the school and/or district
3. Technology Administrator Name and Title: