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Inadvertent Website Access

Please complete the form below. Required fields marked with an asterisk *

Name:

Answer required for "Name:"

Building:

Answer required for "Building:"

User is:

Answer required for "User is:"

Employee

Student

Date of Request

Answer required for "Date of Request"

I inadvertently accessed the following inappropriate website(s) while conducting legitimate educational research or district business.

Website address(es):

Answer required for "Website address(es):"

Brief, general description of inappropriate content (i.e., drug paraphernalia, sexual content, ect.):

Answer required for "Brief, general description of inappropriate content (i.e., drug paraphernalia, sexual content, ect.):"

*Please submit this form to a classroom teacher or building administrator

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For District Use Only

Please submit completed forms firectly to the Director of Technology or designee

Website has been reviewed and Internet blocking/filtering adjusted as necessary

Answer required for "Website has been reviewed and Internet blocking/filtering adjusted as necessary"

Yes

Rationale:

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Signature of Director of Technology or designee:

Answer required for "Signature of Director of Technology or designee:"

Date of approval:

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