Instructions: Please read the Statement of Confidentiality and sign where indicated. The person responsible for Computer Services in your district must also sign. Fax (518)456-9287 or mail the completed form to: NERIC, Network Security Office, 1031 Watervliet-Shaker Road, Albany, NY 12205. This form may be printed and photocopied.
| Last Name: ____________________________________ | First Name: __________________ Middle Initial: _____ |
| District: ______________________________________ | Building: ______________________________________ |
| Street: _______________________________________ | City: ______________________ NY Zip: ___________ |
| Phone Number: (___) ____ - _____________________ | Position: _______________________________________ |
| Password: ___ ___ ___ ___ ___ ___ ___ ___ | IIS Domain Group: ______________________________ |
| Connectivity: [] Dial-up [] Dedicated Line | |
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Passwords are encrypted. Give yourself a 5-8 chararacter password. If you forget your password, call the Help Desk at (518) 456-9099 or (800) 205-0735 |
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Application: [] Classic Internet/Email [] Continental Internet/Email [] GroupWise []Central Site Wisdim [] IIS Domain |
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Statement of Confidentiality
As a user of the Computer System provided for by the Northeastern Regional Information Center, of Albany-Schoharie-Schenectady-Saratoga Counties BOCES, I agree NOT to:
When there is any indication or unauthorized use or abuse of the system or any other action which interferes with the proper functioning of the system, or infringes on the rights of the other users, the NYS Education Department, Capital Region BOCES, or other appropriate agency will be authorized to investigate. Unethical or irresponsible use of the system will be referred to the appropriate authorities for disciplinary or legal action. System users have a responsibility to maintain the integrity of the system and to use it only in an authorized and appropriate manner.
Applicant Signature/Title/Date:
____________________________________________________________
Authorized Signature/Title/Date:
____________________________________________________________
(NERIC Use Only)
| User Id: __ __ __ __ __ __ __ __ District Id: __ __ __ __ __ __ __ __ Date: __/__/__ |