TEA Secure Environment (TEA SE)

Request for Access:
21st Century Community Learning Centers (21stCCLC)

External Customers and Users

To request a new TEASE username, or to modify or revoke existing access to 21stCCLC, complete this form. Obtain the required signatures, and follow instructions in Section 7 for mailing or faxing this form. Your user name and password will be issued to you via email.

*Last Name

*Middle Name

*Organization Name (Use the Name that the grant application was submitted under—Grantee Name or Fiscal Agent organization name.)

*Work Mailing Address

*City

Section 2: Type of Access or Modification Requested

If you do not currently access any TEA automated applications through TEASE, select "New TEASE Account Setup." If you already have a TEASE username and password, select "Update Current TEASE Account Access." Check the appropriate action you are asking TEA to take: CREATE, ADD, MODIFY, DELETE, or REVOKE access.

New TEASE Account Setup

CREATE a new TEA SE username—I don't currently have one.

  I already have a TEA SE username, which is  .

ADD access to 21CCLC.

MODIFY my access to 21stCCLC. My needs have changed.  The modification desired is: .

REVOKE my access to 21stCCLC.  I no longer need access to district or campus-level data.

DELETE my access to all TEA SE applications. 

If deleting or revoking access for another user, please provide your contact name and phone number:

Name

Select one of the following choices, based on the level(s) of data you need to access.
The last choice includes both roles immediately above it. General definitions of each role are given below.

Review, sign and date the “Requestor Certification and Responsibility” statement. Then obtain your District Superintendent’s signature to approve your access request. After you secure the required signoff, please submit the application to TEA via fax or mail at the address given below.

• I agree that my access to 21stCCLC data is for the limited purpose of collecting information maintained on the 21stCCLC database. This information is used by 21stCCLC to document services provided to students and families, report services and evaluate the 21stCCLC program. I also understand that 21stCCLC may use the information to verify 21stCCLC participants, update service information, and provide closure and follow-up information. I understand that any unauthorized disclosure of confidential student information is illegal as provided in the Family Educational Rights and Privacy Act of 1974 (FERPA) and in the implementing of federal regulations found in 34 CFR, Part 99. FERPA is specifically incorporated into the Texas Public Information Act as an exception to records which are subject to disclosures to the public (Government Code, Section 552.026). I understand that any personal characteristics of a student that could make the student's identity traceable, including membership in a group such as ethnicity or program area, are protected, and I will not release counts less than five.

• In addition, I understand that any data sets or output reports that I, or my authorized representative, may generate using confidential data are to be protected. I will not distribute to any unauthorized person any data sets or reports that I have access to or may generate using confidential data. I understand that I am responsible for any computer transactions performed as a result of access authorized through my TEA SE username(s) and password(s).

• I also understand that failure to observe these restrictions is prohibited by the Texas Government Code, Section 552.352, and that such an offense constitutes a Class A misdemeanor.

• I agree that access to confidential data will be limited to the purpose specified above, and agree to limit the data I view to that necessary for that purpose.

• I understand that procedures must be in place to monitor and protect confidential information.

• I understand that release of confidential student information is prohibited by the Texas Government Code, Section 552.352, and that such an offense constitutes a Class A misdemeanor.

• I certify that the information contained in the registration form is, to the best of my knowledge, correct and that the education agency named above has authorized me as a representative. I further certify that any ensuing program and activity will be conducted in accordance with all applicable Federal and State laws and regulations.

Requestor Certification and Responsibility

• I understand that my TEASE username and password are CONFIDENTIAL and may not be shared with another person or entity under any circumstances whatsoever.

• I will neither divulge my password nor use a username and password assigned to someone else.

• I understand that I am responsible for all transactions made with my username and password.

• If I suspect that my password has been compromised, or that someone else has used my account, I understand that it is my responsibility to change my password immediately.

• I will not knowingly or intentionally enter any unauthorized data, or change any data without authorization.

• I agree to notify the TEA Information Security Office when my job responsibilities no longer require access to the requested information, or I terminate employment with my current organization.

• I understand my username and password will expire 15 months from issuance if there is no activity. I will access 21stCCLC at least every 15 months to keep my TEASE username active.

___________________________________

The 21stCCLC Executive Director and the School Superintendent are responsible for revoking the username of persons who are no longer required to have access to district and campus level data through 21stCCLC. By signing this form, the 21stCCLC Executive Director and the School Superintendent are acknowledging and accepting this responsibility.

________________________________________

__________________

TEA SE Username:_________________________________________________________________________

Candace Ferguson
Manager for 21st Century Community Learning Centers
Texas Education Agency
1701 N. Congress Ave.
Austin TX 78701-1494

Phone:(512)463-5619

Or, FAX your request to:

512-463-6782

For assistance in completing this form, please submit questions electronically to Candace.Ferguson@tea.state.tx.us. Please be sure to include your name and a contact phone number (including area code), and be as specific as possible about the problem you are encountering.