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SOFTWARE LICENSE COMPLIANCE
CERTIFICATION FORM

Campus/Site	Division	Department	PO#	Software Name	Vendor	License Type (i.e. Enterprise, Per user, Site license, SaaS)	# of Licenses (for each software named)	Purchase/ Acquisition Date	Expiration Date (if applicable)	Cost

In accordance with LCTCS Policy #7.007 Software License Compliance and the Delgado Information Technology Security Policy , I certify that the above listed software has the necessary and appropriate licensing and that this department adheres to the conditions of use stipulated in the licenses. Furthermore, I understand that failure to comply with the requirements set forth in these policies may result in sanctions to possibly include a verbal or written warning, formal reprimand noted on employee’s evaluation, disciplinary procedures up to and including termination, and/or reimbursement to the College. I also understand that misuse or negligence in ensuring software licensing requirements is a violation of the Student Judicial Code , and accordingly, students are subject to the Code’s requirements and applicable sanctions.

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Division/Department Head (Print Name) Signature of Division/Department Head Date

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Designated Owner-Custodian (Print Name) Signature of Designated Owner-Custodian Date

For OIT Use Only

Approved by: _______________________________________ Date____________________

rev: 1/11/21