First Name:

Last Name:

Employee ID#:

Email Address:

Current school (2010-2011 school year):Aynor HighCarolina Forest HighConway HighGreen Sea Floyds HighLoris HighMyrtle Beach HighNorth Myrtle Beach HighSocastee HighSt. James HighEarly CollegeHorry County Education Cnt.Scholars AcademyAcademy for Arts, Sci. & Tech.Academy for Tech. & Aca.Aynor MiddleBlack Water MiddleConway MiddleForestbrook MiddleLoris MiddleOcean Bay MiddleMyrtle Beach MiddleN. Myrtle Beach MiddleSt. James MiddleWhittemore Park MiddleAynor Elem.Burgess Elem.Carolina Forest Elem.Conway Education CenterConway Elem.Daisy Elem.Forestbrook Elem.Green Sea Floyds Elem.Homewood Elem.Kingston Elem.Lakewood Elem.Loris Elem.Midland Elem.Myrtle Beach Elem.Myrtle Beach Interm.Myrtle Beach PrimaryN. Myrtle Beach Elem.N. Myrtle Beach Interm.N. Myrtle Beach PrimaryOcean Bay Elem.Palmetto Bays Elem.Pee Dee Elem.Seaside Elem.Socastee Elem.South Conway Elem.St. James Elem.Waccamaw Elem.Adult Ed.District OfficeMaintenanceTransportation

Do you anticipate being at the same school next year?  Yes No

Have you participated in the Laptop initiative? Yes

What subject do you teach?

What grade(s) do you teach?

Do you currently have a SMARTboard in your classroom?  Yes  No

Do you have a mounted projector in your classroom? Yes No

Which equipment are you applying for? (please select from the list below)

SMARTboard

Slate - by SMART (handheld tablet allowing you to be mobile and interactive using SMART software(

MOBI (upgraded version of the Interwrite Pad - also mobile and interactive but uses Interwrite software)

Why have you selected the equipment above and how will you implement the new technology into your classroom instruction?