Arkansas Public School Computer Network
Arkansas Public School Computer Network
FY 2004
STATEWIDE INFORMATION SYSTEM (SIS) COORDINATORS
APPLICATION FORM
EDUCATIONAL SERVICE COOPERATIVE:
Coop Name:_____________________________________
DISTRICT:
Name: __________________________________________
Address: __________________________________________
City/Zip Code: __________________________________________
Phone Number: ________________ Fax Number:_______________
SIS COORDINATOR:
Full Name: _______________________________________________
Login Name: _______________________________________________
(Login should be the same as it is accessing Pentamation software)
Phone Number: _______________________________________________
CYCLE 1 COORDINATOR (if different than above):
Full Name: _______________________________________________
Login Name: _______________________________________________
(Login should be the same as it is accessing Pentamation software)
Phone Number: _______________________________________________
SUPERINTENDENT - SIGNATURE AND DATE:
__________________________________________ _______________
Superintendent=s Signature Date
................
................
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