Request for Services Application
By completeing and signing the form below you certify that you have participated in an initial consultation and that you agree to the terms below:
Nonpublic School Signature and Assurances
The school district assures the PAL – PCC Team, contractors for this program, that:
          - it is requesting funds, in the amount indicated, in accordance with Title II, Part D of the Elementary and Secondary Education Act, as             amended by the No Child Left Behind Act,
          - it will assist in developing a service plan that addresses the needs of the school's students and teachers in an effort to satisfy the goals of the             Enhancing Education Through Technology program,
          - it will keep records and information necessary for program auditing, evaluation, and reporting,
            all property purchased under this program will be inventoried and clearly identified as property of ED,
          - it understands that periodical desk and on-site monitoring will occur to include review of the secular nature of the services, how these services             benefit the children/teachers, and that the services meet the needs of the private school children, not the needs of the school itself.
          - it will not make purchases (allocating grant money) itself, but rather pass all request through the PAL-PCC Team. It also understands that the             consequences of doing so will result in the school itself being liable for the cost of the purchase.

Forms and Instructions

If you would like a paper copy of the form above, follow the indtructions below:
PDF and Word files are provided for all
forms and can be view and saved with
the corresponding programs.
(Adobe Acrobat = .pdf
Microsoft Word = .doc)

To Download:
1. Click on the link for the file(s) you wish to have.
The corresponding program should open them on your computer.

2. In the upper left hand corner of your screen select file then print.
Click file then save as if you would like to retain the selected file.

List of Files:

Request for Services Form: (.doc) (.pdf)

Inventory Report Form: (.xls)

Click here to access the Request for Services Application Database (authorized personnel only)