A r c h i v e d  I n f o r m a t i o n


APPENDIX C

Recommended Application Forms


Schools and Libraries Universal Service Fund

Application for Eligible Services

FCC Form I


BLOCK 2: Services Requested


7. Please write a short summary description of the objectives sought to be achieved by the services requested.
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________




8. Please check off the eligible service(s) requested.
Add an additional list for any requested eligible service not included in the checklist.
Internal connections

    Voice network


    Number of Nodes
¤ 1-20
¤ 21-50
¤ 51-100
¤ 101-250
¤ 251-500
¤ greater than 500


    Other features
¤ Intercom
¤ 1 way
¤ 2 way
¤ Dial in only
¤ Dial out only
¤ Other (specify)
____________________


    Data/LAN, including Intranet


    Speed
¤ 10 mbps or less
¤ greater than 10 mbps


    Number of LANs
¤ 1-2
¤ 3-5
¤ 6-10
¤ 11-20
¤ greater than 20


    Number of Nodes per LAN
¤ 1-20
¤ 21-50
¤ 51-100
¤ 101-250
¤ 251-500
¤ greater than 500


    Number of Facilities/Buildings
¤ 1-2
¤ 3-5
¤ 6-10
¤ 11-20
¤ greater than 20


    Other Features
¤ Other (specify)
____________________


    Video


    Speed
¤ less than 56 kbps
¤ 56-less than 400 kbps
¤ 400-less than 1.6 Mbps
¤ greater than 10 Mbps


    Number of Nodes
¤ 1-20
¤ 21-50
¤ 51-100
¤ 101-250
¤ 251-500
¤ greater than 500


    Number of networks
¤ 1-2
¤ 3-5
¤ 6-10
¤ 11-20
¤ greater than 20


    Other Features
¤ Dedicated
¤ Switched
¤ Other (specify)
____________________


    External connections


    Voice








¤ Basic telephone:
incoming _____
outgoing _____
extention paths _____
¤ Usage
¤ Toll
¤ Custom features
¤ Other (specify)
____________________


    Data


    Speed
¤ less than 56 kbps
¤ 56-400 kbs
¤ 400-1.6 Mbs
¤ 1.6-10Mbs
¤ Other (specify)
____________________


    Other Features
¤ Dedicated
¤ Switched
¤ Other (specify)
____________________


    Number of locations
¤ 1-2
¤ 3-5
¤ 6-10
¤ 11-20
¤ greater than 20


    Video


    Speed
¤ less than 56 kbps
¤ 56-400 kbs
¤ 400-1.6 Mbs
¤ 1.6-10 Mbs
¤ Other (specify)
____________________


    Other Features
¤ Dedicated
¤ Full motion
¤ Switched
¤ Compressed rate (specify)
____________________


    Internet services


    Speed
¤ less than 56 kbps
¤ 56-400 kbs
¤ 400-1.6 Mbs
¤ 1.6-10 Mbs
¤ Other (specify)
____________________


    Number of students (potential e-mail addresses)
¤ 1-20
¤ 21-50
¤ 51-100
¤ 101-250
¤ 251-500
¤ greater than 500


¤ Check if applicant has detailed descriptions of the services requested, suc has a request for Proposals.
Applicant will make those documents available upon request.
¤ Check if applicant is subject to any restrictions or requirements on procurement imposed by State or local laws.
Applicant will make their details available upon request.
Approximate installation date _____/ _____/ _____


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[ Form I, Block 1:
Applicant Information 		Return to Appendix C. Recommended Application Forms [ Form I, Block 3:
Supplemental Information ]

This page last updated 8/10/97 (pjh).