FCC Form
 		Approval by OMB
3060-0806
470 Schools and Libraries Universal Service
Description of Services Requested
and Certification Form

Estimated Average Burden Hours Per Response: 6.0 hours

This form is designed to help schools and libraries describe the eligible telecommunications-related services they seek so that this data can be posted on a website and interested service providers can identify the applicant as a potential customer and compete to serve it.
Please read instructions before completing. (To be completed by entity that will negotiate with providers.)
Block 1: Applicant Address and Identifications
(School, library, or consortium desiring Universal Service funding.)
Posting Date:    12/17/1998
Allowable Contract Date:    01/14/1999
Certification Received Date:   

1. Name of Applicant:
 HACKENSACK SCHOOL DISTRICT		 2. Funding Year:
 07/01/1999 - 06/30/2000
3a.NCES School Code (if individual school) Or NCES Library Code(if individual library)
State: 34 -  District: 06270 -  School/Library: 
3b. Universal Service Control Number:
  977580000120513 		3c. Applicant ID Number:
  122884
4a. Type Of Applicant
(Check only one box.)
 school
 school district
 library or library consortium under the LSTA
 consortium of multiple entities
4b. If Applicant is a consortium, check all other boxes that apply:
 includes non-governmental entities ineligible for support
 entity desires separate bills for each member of consortium
 entity desires separate bills for some members of consortium
 region of a state  statewide multi-state
 state educational agency
 local educational agency
 educational service agency
5. Applicant's Street Address, P.O.Box, or Route Number
Street
355 STATE ST
City
HACKENSACK 		State
NJ 		Zip Code 5Digit
07601 		Zip Code 4Digit
5510
Telephone number      Ext:
(201) 6467810     		E-mail Address
6. Contact Person's Name: Robert DiAmbrosio
Street Address, P.O.Box, or Route Number( if different from Item 5)
Street:
355 STATE ST
City:
HACKENSACK 		State
NJ 		Zip Code 5Digit: 
07601 		Zip Code 4Digit: 
5510
Fill in all of the following(if available), and check the preferred mode of contact:
 Telephone Number  Ext:
 ()     		 Fax Number      Ext:
 () 		 E-mail address:
 impala09@ix.netcom.com 		 Mail:

Block 2: Other Characteristics Of Applicant

7a. Number of students:
4498 		7b. Number of library patrons:
8. Number of buildings to be served:
6 		9. Number of rooms to be served:
180

Block 3: Summary Description of Needs or Services Requested

10.   Check if applicant seeks discounts only for eligible services based on one or more existing,binding contract(s) and proceed to Block 4.
Sequence # Date Contract Signed Contract Termination Date
11.   Check here if you have a Request for Proposal(RFP) available.If RFP is posted on a website, provide the website address
(1)
(2)


Existing
Services
(3)

Additional
Services
Desired
(4)

Total
Services
Desired
(5)


Details(Optional)
12. Telecommunications Services
a. Number of phones that have or require service (See instructions concerning extension phones and fax machines.) 285 0 285
b. Number of computers that have or require service 250 150 400
c. Number of high bandwidth video conferencing links 1 0 1 ITV Link
d. Specify other (Optional)
13.Internal Connections
Existing
Additional
Total
Details
a. Number of buildings with at least some rooms connected 6 0 6
b. Number of rooms connected 60 120 180
c. Highest Speed of connection T1 0
d. Specify other (Optional)
14.Internet Access
Existing
Additional
Total
Details
a. Number of dial up connections necessary 9 0 9
b. Highest speed of dial up connections ISDN 0
c. Number of direct connections necessary 6 0 6
d. Highest speed of such direct connections T1 0
e. Specify other (Optional)
15. You may provide additional summary information about the services you are requesting to help service providers identify your needs more precisely.You may provide technical requirements or give an informal description of your telecommunications-related goals.

16.    Check here if there are any restrictions imposed by state or local laws or regulations on how and when providers may contact you or on other bidding procedures.Please describe below any such restrictions or procedures. You may attach restrictions or give website where they are posted.

NJ Title 18A NJDBC Telcom. Exemp. Card/Dept of Treasury
17.  Purchases in future years: If you have current plans to purchase additional services in future years, describe them below (Providing this information is optional.)


Block 4: Technology Assessment

18. Although the following services and facilities are ineligible for support, they are usually necessary if schools and libraries are to make effective use of the eligible services requested in this application.
(If your application is only for basic voice telephone service, check this box
and go to Item 19. Otherwise, you must check at least one box in each of the other lines. You may provide details for purchases being sought.)
a. Desktop communications software: Software required   has been purchased; and/or   is being sought.
b. Electrical systems:   adequate electrical capacity is in place or has already been arranged; and/or   upgrading for additional electrical capacity is being sought.
c. Computers: a sufficient quantity of computers   has been purchased; and/or   is being sought.
d. Computer hardware maintenance: adequate arrangements   have been made; and/or   are being sought.
e. Staff development:   all staff have had an appropriate level of training or additional training has already been scheduled; and/or   training is being sought.
f. Additional details: Use this space to provide additional details to help providers to identify the services or facilities you desire.

Block 5: Listing Consortium Participants

19. Eligible Entities: (Billed Entities.) If applicant is an individual school or a library or a school district or a library system that will receive only one bill, it should only fill in the first row of this chart. If applicant is a consortium of multiple billed entities, then it should fill out a row for each billed entity. (Applicant may attach additional pages.)

Billed Entity Billed Entity's Zip Code Billed Entity Code
(Inserted by Administrator) 		Zip Code(s) of Recipients of Service
  HACKENSACK SCHOOL DISTRICT   07601   122884  

20. Entities Ineligible for Schools and Libraries Discount:

Name of Entity Zip Code(s) of Recipients of Service Contact Person Phone Number, E-mail Address, or Alternative Preferred Contact Method


Block 6: Certfications and Signature



21. The applicant includes:(Check one or both)
a.   schools under the statutory definitions of elementary and secondary schools found in the Elementary and Secondary Education Act of 1965, 20 U.S.C. Secs. 8801(14) and (25), that do not operate as for-profit businesses, and do not have endowments exceeding $50 million; and/or
b.   libraries or library consortia eligible for assistance from a State library administrative agency under the Library Services and Technology Act of 1996 that do not operate as for-profit businesses and whose budgets are completely separate from any school(including, but not limited to) elementary and secondary schools, colleges, and universities.
22. All of the individual schools, libraries, and library consortia
listed above in item 19 are covered by:
a.   individual technology plans and/or
b.   higher-level technology plans for using the services requested in this application(if those services consist of other than voice services).
23. Status of technology plan(check one):
a.   Technology plan(s) has/have been approved; or
b.   Technology plan(s) will be approved by a state or other authorized body; or
c.   Technology plan(s) will be submitted to Schools and Libraries Corporation for approval.
24.   I certify that the services the applicant purchases at discounts provided by 47 U.S.C. Sec. 254 will be used solely for educational purposes and will not be sold, resold, or transferred in consideration for money or any other thing of value.
25.   I recognize that support under this program is conditional upon the school(s) or library(ies) I represent securing access to all of the resources, including computers, training, software, maintenance, and electrical connections necessary to use the services purchased effectively.
26.   I certify that I am authorized to submit this request on behalf of the above-named applicant, that I have examined this request, and to the best of my knowledge, information, and belief, all statements of fact contained herein are true.
29. Printed name of authorized person    
Robert DiAmbrosio
30. Title or position of authorized person 
Technology Coordinator


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