Technology Access Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Technology Access Form, please complete this form to gain technology access within the district. THIS FORM MUST BE COMPLETED BEFORE EMAIL ACCESS, COMPUTER ACCESS, OR ACCOUNT ACCESS CAN BE ISSUED. Access to any of Hollandale School District software or equipment is a privilege and should be treated as such. Upon leaving the district all rights and privileges are revoked immediately.

Email *

Today's Date: *

YYYY

First Name: *

Last Name: *

Middle Initial:

Phone: *

Date of Birth *

YYYY

Last Four Digits of Social Security No: *

Select the school in which you are employed: *

Sanders Elementary School

Simmons Jr/'Sr High School

District Personnel

Required

Check all the software access that you are requesting: *

HSD Computer Access

HSD Email Access

SAMs Student Information System

MSIS - Mississippi Student Information System ( Access to this system must be approved by your Direct Supervisor and additional paperwork is required.)

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Hollandale School District.

Does this form look suspicious? Report

Forms