USER AUTHORIZATION REQUEST and REQUIREMENTS

CERTIFICATION of IDENTITY

DESIGNATION of REPRESENTATIVE

USER AUTHORIZATION REQUEST and REQUIREMENTS

RequirementsandRequestforSchoolDistrictandCharter School Access

Idaho StateDepartment OfEducationData SystemApplications

Incompliance with theFamilyEducational Rightsand PrivacyAct (FERPA),theStatewideLongitudinal DataSystem (SLDS) shields unauthorized users fromaccessingdatathatis madeavailable byvarious IdahoStateDepartmentofEducation(SDE)softwareapplications.

To ensurepropersecuritymeasuresfor access toSDEapplications,theSDErequires thateachSchoolDistrict Superintendent andCharterSchoolAdministratorcomplete, signandsubmittotheSDE,a Certificationof Identity andAcknowledgmentof Status as UserAuthorizationAuthority. AccesstoSDEapplicationsbyusersauthorized by the schooldistrictorcharterschool is contingent uponthesubmissionofthis requiredform. The completed formshouldbeemailed tothe SDE’, by the Superintendent or Charter School Administrator.Theoriginal versionof the completed and signed formmustbemailedwithinfourteencalendardaysof theemail to:

IdahoStateDepartmentofEducation

650WestState Street, Suite343

Boise,ID83720.

EachSchoolDistrictSuperintendent and CharterSchoolAdministratoris responsible forgrantingaccess forthe district’sorcharterschool’s userstoSDEapplications,ensuringthateach userhas alegitimate“educationalinterest” inthestudentandthestudent’sdata towhichaccess is beinggranted,andforensuringthatanyre-disclosures of informationbysuchuserscomply with all applicablestateandfederal statutes andregulations.

Each School District Superintendent and CharterSchoolAdministrator is also responsible for ensuring the district’s or charter school’s users accessing or making use of the Electronic Forms and Rubrics for Enhancing Professional Practice: A Framework for Teachingthrough SDE applications comply with the Downloadable Product License between the SDE and the Association for Supervision and Curriculum Development (ASCD). See ______[link to ASCD license agreement]______). In addition, each School District Superintendent and CharterSchoolAdministrator acknowledges that ASDC is a third-party beneficiary to the agreement between the district or charter school and the SDE represented by the terms of this form.

Bycompletingthesectionsbelow,DistrictSuperintendentsandCharterSchool Administratorsacknowledgetheir understandingof theconditions regardingdata accessandestablishing of authorized delegatesfortheDistrict/Charter managementof data access throughSDEapplications.

Penalties,includingbutnotlimited to,datasystemaccessdenial,maybeimposedfor thefailuretoactinamanner that isinaccordancewith theconditions above. Sharingof useraccountinformation(i.e.usernamesandpasswords) byan authorized individualtoothersisprohibited.

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CERTIFICATION of IDENTITY

I, _,holdingthepositionof

Superintendent-CharterSchoolAdministrator(circleone) herebycertifythatI havereceived,read, and agree to theconditionsinthe RequirementsandRequestforSchoolDistrictandCharter School AccesstoIdaho StateDepartment OfEducationData SystemApplications document (Page 1), andtheinformationsubmittedbelowis true andcorrect.

SuperintendentorCharterSchool Administrator Information:

PrintedName:

DistrictNameandNumber:

SchoolDistrict BusinessAddress

City: State: Zip:

Phone: Fax:

Email:

Signature:

Date:

All DistrictSuperintendentsor Charter School Administrators mustcompletethis formtogainaccesstoSDEdata systems. Superintendents, from your email address, pleaseemail completed andmail theoriginal, signed forms, toSDE(IdahoStateDepartmentof Education650West StateStreet, Suite343Boise,ID 83720).

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DESIGNATION of REPRESENTATIVE

A DistrictSuperintendentorCharterSchoolAdministratormaydelegateauthorizationandmanagement duties to users of SDEdatasystemapplications toaDesignatedRepresentative,whomustbeanemployeeofthe school districtor charterschool.The SuperintendentorCharterSchoolAdministratormakingadelegation, however,shallbe responsible forthe acts,orfailuretoact, ofthedesignatedrepresentative. Incases ofsuchdelegation, the respective SchoolDistrictSuperintendent orCharterSchoolAdministratorandtherespectiveDesignatedRepresentativemust complete,sign andsubmit the Certification of Identity form (Page 2), Designation of Representative form (Page 3) and Representatives Certificate of Acknowledgement form (Page 4). The completed formsshouldbeemailed tothe SDE’s IdahoStateDepartment from the Superintendents email address. Thecompleted and signed formsmustbemailedwithinfourteencalendardaysof theemailto:

IdahoStateDepartmentofEducation

650WestState Street,Suite343

Boise,ID83720.

I, ,holdingthepositionof

Superintendent \ CharterSchool Administrator(circle one),herebydelegateauthority formyschool district or charterschool theresponsibilityfor theestablishmentandmanagementof user accesstoSDEdata systemsas outlined intheRequirementsandRequestFor SchoolDistrictAndCharterSchool Access toIdahoState Department of EducationDataSystemApplications (Page 1) to _,whoholdstheorganizational positionof . I certify thatI havedistributedandreviewed the RequirementsandRequestforSchool DistrictandCharterSchoolAccess toIdahoStateDepartmentof Education Data SystemApplicationsdocument(Page 1) withmy Designated Representative,andinstructedtheRepresentativeto completetheRepresentative’sCertificateandAcknowledgement form (Page 4).

Superintendent/CharterSchoolAdministrator Signature:

______

District: ______

Date:

This formisrequired iftheSuperintendentor CharterAdministrator desirestodesignatesomeonetomanagelocal useraccesspermissionstoSDE datasystemsotherthanthemselves. Superintendents, pleaseemail completed forms , andmail the original, signed forms withinfourteencalendardaysof theemail,to SDE(IdahoStateDepartment ofEducation, 650WestStateStreet, Suite343Boise,ID 83720).

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REPRESENTATIVE’S CERTIFICATE of ACKNOWLEDGEMENT FORM

I, ,holdingthepositionof

herebycertifyandacknowledgethat the District

Superintendentor CharterSchool Administratorof_(Districtor CharterSchoolname) has authorizedme toactas their agent for thepurpose ofestablishingandmaintainingIdahoState Department of Educationdata applicationuseraccessauthorizationpermissions as described withintheRequirementsandRequest For SchoolDistrictandCharterSchoolAccess (Page 1) . I haveread theRequirementsandRequestforSchool Districtand CharterSchoolAccess toIdahoStateDepartmentof EducationData SystemApplications (Page 1) andagreetothe conditions therein.

______

PrintedNameofDesignatedRepresentative

______

Signature ofDesignatedRepresentative

______

District orCharterSchool Name/number

______

PhoneNumber/Email Address

Date: ______

If theSuperintendentor CharterAdministratorchooses todelegatetheir SDEuser accessmanagement responsibilities, theDesignatedRepresentativemustcompletethis form. andmail the original, signed formwithinfourteencalendardaysof theemail, toSDE(IdahoStateDepartmentofEducation650WestStateStreet, Suite343Boise,ID 83720).

Education Unique ID (EDUID) User Authorization

______

PrintedNameofAuthorized Representative

______

Date

______

District orCharterSchool Name and State Number

______

Signature ofAuthorizedRepresentative

The People listed below have my permission to access the Education Unique ID Application on behalf of my school district or Charter School

______

Person 1 Name

______

Person 1 Email Address

______

Person 1 Phone Number

______

Person 2 Name

______

Person 2 Email Address

______

Person 2 Phone Number

______

Person 3 Name

______

Person 3Email Address

______

Person 3 Phone Number

This form is required for user access to the EDUID application; it must be completed by the District Superintendent, Charter School Administrator, or their DesignatedRepresentative.

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