TEXAS EDUCATION AGENCY .tx.us



TEXAS EDUCATION AGENCY

Confidential Louisiana Student Records (LSR)

Request for Access

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To request access to confidential data stored within the Louisiana Student Record (LSR), complete this form, print, obtain the required signature of your Superintendent, and follow the instructions in Section 3 for submitting the form to the TEA PEIMS Division. Only district or campus employees who already have access to PID may have access to LSR. Please complete the information for up to six people per page.

|Section 1:  Requestors Information | | | | |

|Today's Date (MM/DD/YYYY) |Region Number |Contact Phone No. | | | |

|[pic] |[pic] |[pic] | | |

|1. TEASE Username |County/District/Campus No. |Last Name |First Name and Middle Initial | | |

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|2. TEASE Username |County/District/Campus No. |Last Name |First Name and Middle Initial | | |

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|3. TEASE Username |County/District/Campus No. |Last Name |First Name and Middle Initial | | |

|[pic] |[pic] |[pic] |[pic] | | |

|4. TEASE Username |County/District/Campus No. |Last Name |First Name and Middle Initial |

|[pic] |[pic] |[pic] |[pic] |

|5. TEASE Username |County/District/Campus No. |Last Name |First Name and Middle Initial |

|[pic] |[pic] |[pic] |[pic] |

|6. TEASE Username |County/District/Campus No. |Last Name |First Name and Middle Initial |

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|  Superintendent's Signature: | | |

 

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|Section 3: Submitting Your Request |  |

|To complete your application:  |

|Print the completed form.  |

|Submit the completed form to your superintendent for approval. |

|Fax all pages of the approved application to: |

|Texas Education Agency |

|Attn:  TEA PEIMS Division |

|FAX:  512-463-9330 |

|Last Updated: 9/13/2005[pic] |

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