Texas Education Agency Security Environment (TEASE)

Request for Access to Web Application

The Perkins Grant Application (Perkins)

To request a new user ID or to modify or revoke existing access to the web application, complete this form and follow instructions for mailing or faxing the form.

Section 1:  Requestor Information

*Today's Date (mm/dd/yyyy):
*Date ID Needed (mm/dd/yyyy):
*First Name and MI:
*Last Name:
*Organization:
*County District Number
ESC Number (if applicable)
*Job Title:
*Work Address:
*City:
*ZIP:
*Email Address:
*Phone:
Fax:

*Required Information

Section 2:  Type of Access or Modification Requested

Specify your request by selecting one of the options below:
      Existing User Name:
      Desired Modification(s):
Signature of Requestor _______________________________________ Date: ____________
Signature of Supervisor/Manager: _______________________________  Date: ____________
This area to be completed by TEA Security Administration:
TEASE User ID:_________________________________________ Initial Password:_____________
Program Coordinator Signature:_____________________________  Date:____________________
Security Administrator Signature:____________________________  Date:____________________
 

Section 3: Web Application Status

List any TEA web applications to which you already have access, and note your current User ID:
.
Example: WEB ER, jsmith

Section 4: Submitting Your Application

To complete your application:
1. Print and sign the completed form. 
2. Submit the signed form to your manager for approval. 
3. Mail or fax the application, signed by you and your manager, to the address below.  
     Trudy Rotan
     Texas Education Agency
     1701 North Congress Avenue
     Austin, TX 78701-1494 FAX:  512-475-3575