External Coordinator form

Education Sector Authentication and Authorisation (ESAA) User Setup and Access Request Form SUPPORTING LEARNING IN A CONNECTED SECTOR THROUGH THE SMART USE OF ICT e-asTTle User Setup and Access Request Form Page 1 of 2 e-asTTle Access Request Form This form should be completed and sent either: • via fax to the Sector Service Desk, 04 463 2868 or • by post to Sector Service Desk, Ministry of Education, PO Box 1666, Wellington Please print clearly in black or blue ink. Fields denoted with an * are mandatory. For help completing this form please contact the Sector Service Desk on 0800 225 5428 Section 1 Applicant Details ESAA User ID (if applicable) Title First Name * Middle Name * Last Name * Preferred Name (if different) Date of Birth * (dd/mm/yyyy) Gender * Male Female Place of Birth * (Town/City) Country of Birth * Work Phone * Work Fax Work Email * Section 2 e-asTTle Access Request Indicate Type of Access Required If more than one type of access is required, please tick each applicable role Online Services Role * Required Trust Level External Coordinator Allows the creation, assignment and marking of tests, as well as the viewing of test results and reports within or across schools 0 Education Sector Authentication and Authorisation (ESAA) User Setup and Access Request Form SUPPORTING LEARNING IN A CONNECTED SECTOR THROUGH THE SMART USE OF ICT e-asTTle User Setup and Access Request Form Page 2 of 2 Applicants Declaration and Acceptance of Conditions for ESAA I declare that all information included in this application is true and correct. I certify that for the purpose of my ESAA authentication access to personal and other information held by the Education Sector: 1. I will follow lawful and relevant instructions issued by the Ministry. 2. I have read and understood the conditions of use detailed on the MoE website. 3. I will not share my User ID or Password with another person. 4. I will ensure information, to which I have access, is used in accordance with the Privacy Act 1993. 5. I understand that my failure to use information in accordance with conditions 1 to 4, or the provision of incorrect information, may result in my access to Education Sector online services being declined or cancelled. 6. I have read and accept the above conditions. ________________________________________ ________________________ Applicant’s Signature Date Section 3 Manager Confirmation Full Name * Position /Role * Organisation * Confirmation Place Organisation Stamp Here 1. I confirm that I have identified the person requesting access who has signed the declaration. 2. I confirm the applicants request for e-asTTle access. 3. I confirm my details are valid and correct. ________________________________________ ________________________ Manager’s Signature Date MoE use only Verified By /Date Issued By /Date Notes