eLearning Academy (eLA)
eLA Resource Reference No.
REQUEST FOR eLEARNING RESOURCES Type of Resource: (Highlight or Shade ONE) Software Tool Hardware Device
Video or Digital Devices
eLA facilities
Others (please specify):
Applicant’s Name: Staff ID No.:
Date of Request:
Division / School: Email: Contact: Date of Request: Expected Delivery: Location Cost per unit:
Total Cost (RM):
Budget Reference:
eLITe Grant
School / Division
Others
Purpose / Objectives:
Checklist: (Give detailed information with references & web site addresses where possible) Resource Malaysia Singapore Others: Availability: Online Reference (URL): Contact (Email / Phone):
Industry:
Online Reference (URL): Contact (Email /
Others:
Phone):
University: Currently Used By:
Runs On:
Windows
Mac
Mobile
iPad
Single User
Server
Campus
Open Source
Academic
Others:
Vendor Support:
Onsite
Third-party
Phone
Others:
Documentation:
Download: Free / Paid
Training: Free / paid
Include dev. kit
Hardcopy
Licence Type:
Online (Forum) Include tutorials
Value Add Benefits: Limitations:
Applicant Signature:
Approved By:
Name:
Name:
Date:
Designation:
Others:
None