IT Accounts Request

Technology Account Request Form

By filling out this form new employees will receive the following accounts:

Network
E-mail

If you only need 1 of these types of accounts please indicate that in the comment section. Thank you.

First Name *

Middle Initial *

Last Name *

Address

Address

City

State

Zip Code

Gender

Male

Female

Ethnicity

Home Phone

Date of Birth

Month

Day

Year

Home Email Address

Select Your School

Culver High School

Culver Middle School

Culver Elementary School

District Office

Job Title

Position

Work Location / Room Number

Requested Password *

Must be 8 characters or more.

Email Password (if different)

Network Password (if different)

Comments

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Culver School District #4 | PO Box 259 | 412 West E Street | Culver, OR 97734
P: (541) 546-2541 | F: (541) 546-7517

Culver School District #4 does not discriminate on the basis of race, religion, color, national origin, disability, marital status, sex, sexual orientation, veterans' status, genetic information or age in providing employment, education or access to benefits of education services, activities and programs in accordance with Title VI, Title VII, Title IX and other civil rights or discrimination issues; Section 504 of the Rehabilitation Act of 1973, as amended; and the Americans with Disabilities Act; and the Americans with Disabilities Act Amendments Act of 2008.

The following person has been designated as a contact regarding these legal requirements and may be contacted for additional information and/or compliance issues: Barbara Garland, Special Education and Title Programs Director, bgarland@culver.k12.or.us (541)-546-2541

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