Network Access Request Form
This form should be used by Sponsors on behalf of the individual needing an account. A Sponsor is an employee of the Birmingham City Schools in the position of Director, Manager or Principal.
Sponsor's Name: *
Sponsor's Employee ID: *
Sponsor's Department: *
Sponsor's Email Address: *
Sponsor's Phone #: *
Contractor's Name: *
Contractor's Position: *
Contractor's Assigned School/Facility: *
Contractor's Personal Email Address: *
Contractor's Phone #: *
Contractor's Assignment End Date: *
The maximum length of time is one (1) year.
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Access/Account Requested: *
Required
Reason for Access: *
Sponsor's Signature: *
Please certify your authorization by submitting an electronic signature (type your full name below). I authorize the requested access for the individual listed above.
Date of Submission: *
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Submit
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