PO Box/Street Address City Zip Code Description of Equipment Model No. Cost per Purchase Date Tag No. Program Unit ____________________________________________________________________________________________________ KBOR Representative Title Date Electronic copies available at: Appendix CC Carl Perkins Requests Professional Development – AY 17-18 Name: __________________________________ Program: ________________________________ Description (Type of activity, provider, location, dates, etc.):
PO Box/Street Address City Zip Code Description of Equipment Model No. Cost per Unit Purchase Date Tag No. Program ____________________________________________________________________________________________________ KBOR Representative Title Date Electronic copies available at: Appendix CC Carl Perkins Requests – Professional Development AY 17-18 Name: __________________________________ Program: ________________________________ Description (Type of activity, provider, location, dates, etc.):