Section 1: User
Information |
*Today's Date
(MM/DD/YYYY) |
*Date Required
(MM/DD/YYYY) |
|
|
*Last
Name |
*First Name and Middle
Initial |
|
|
*Job
Title |
|
|
*Organization |
|
|
*Work
Address |
|
|
|
*City |
*Zip
Code |
|
|
*County/District
Number |
*Region
Number |
|
|
*Phone
Number |
*FAX
Number |
|
|
*E-mail
address |
|
|
* = Required
information |
|
Section 2. Type of Access Requested.
|
Only one person per district may be
designated as a data entry user for a specified program. Select as many programs as
applicable:
|
-
I understand that I am responsible for all transactions made with
my username and password.
-
I will neither divulge my password nor use a username and
password assigned to someone else.
-
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 entity.
-
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.
Select one action:
I do not have a TEA SE
username. Please create one for me.
I already have a TEA SE username for another
application. Please add MT
permissions to my existing user name.
My username is
|
|
|
*User's
Signature (above) |
Date (above) |
|
|
*Superintendent's
Signature & Date (above)
(district/region/campus staff)
or TEA Division Director's
Signature (TEA staff) |
*Superintendent's Typed Name
& Title (above)
(district/region/campus staff)
or TEA Division Director's Typed
Name (TEA staff) |
Section 3: Other
District Contact Information |
District Business
Manager |
*Typed Name: |
*Phone: |
*Fax: |
*Email:
|
Master Reading Teacher District Coordinator |
*Typed Name: |
*Phone: |
*Fax: |
*Email:
|
Master Math Teacher District Coordinator |
*Typed Name: |
*Phone: |
*Fax: |
*Email:
|
District Superintendent |
*Typed Name:
|
*Phone: |
*Fax: |
*Email:
|
* = Required information |
|
Section 4: Revocation
or Modification Requested |
Select one action:
This
person no longer performs MT Data Entry, but is still employed at this
district. Please revoke his/her access to MT:
This person is no longer employed at this
district. Please delete his/her TEA SE username:
|