Fillable Homeroom Administrator Update Form hange Existing Homeroom Administrator (The State of New Jersey)

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Homeroom Administrator Update Form hange Existing Homeroom Administrator (The State of New Jersey)

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Homeroom Administrator Update Form
New Form!
Directions:
1. Download the form.
2. Open the form in Adobe or any
application that can read a .pdf format.
3. Print for signatures, then scan and email.
NJDOE Department of Information Technology Revised: February 201
Please choose one of the following options:
☐ C
hange Existing Homeroom Administrator
☐ Create New Homeroom Administrator (for new districts/LEAs only)
D
ATE
:
/ /
E
NTITY
T
YPE
:
(check one)
☐
Public District
☐ Charter
☐ College
☐ Nonpublic School
☐ Approved Private School for Students with
Disabilities (APPSD)
C
OUNTY
NAME:
C
OUNTY
C
ODE
:
E
NTITY
C
ODE
:
E
NTITY
N
AME
:
HOMEROOM ADMINISTRATOR INFORMATION – please print
N
AME
:
USER NAME:
(must be 6 – 8
characters)
P
HONE
:
EMAIL:
( )
☐ I
CERTIFY THAT I WILL BE THE HOMEROOM ADMINISTRATOR FOR MY DISTRICT AND WILL BE REPLACING THE CURRENT HOMEROOM
ADMINISTRATOR AND WILL BE RESPONSIBLE FOR UPDATING ALL USER ACCOUNTS IN THE DISTRICT.
S
IGNATURE: ___________________________________________
AUTHORIZATION
C
HIEF
S
CHOOL
A
DMINISTRATOR
I
NFORMATION
– please print
N.J.A.C. 6A:32-2.1 Chief School Administrator means the superintendent of schools or the administrative principal if there is no
superintendent.
N
AME
:
P
HONE
:
( )
E
MAIL
:
☐ AS THE CHIEF SCHOOL ADMINISTRATOR (CSA), I HEREBY AUTHORIZE THE INDIVIDUAL WHOSE SIGNATURE APPEARS ABOVE TO ADMINISTER
ALL
HOMEROOM ACCOUNTS FOR USE WITHIN MY INSTITUTION.
S
IGNATURE: ___________________________________________
Next Steps:
1. Please email the completed form to NJDOE’s Office of Information Technology: doeit@doe.nj.gov and copy
(Cc) your CSA.*
2. *You must Cc your CSA. Forms without the CSA Cc’ed will not be accepted.*
3. NJDOE’s Office of Information Technology will call you upon receipt of the form to finalize your account.
✔
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Homeroom Administrator Update Form hange Existing Homeroom Administrator (The State of New Jersey)

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Completed 18 June 2021

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