Republic of the Philippines Document Code:

Department of Education SDO-KAL-OSDS-ICT-GQF-02

Cordillera Administrative Region Revision: 00
SCHOOLS DIVISION OF KALINGA Effectivity date: 10-01-2018

ACCOUNT REQUEST FORM

Name of Office: ICTS

Date: School ID: Control No.:

2018- __ __- __ __ __ __
Division/Unit/District: School Name:

First Name Middle Initial Last Name User Account (DepEd Email, LIS, EBEIS, EHRIS, etc.)

Nature of Request:
____Account Creation ____Password Reset ______Account/Role Modification
Action Taken: _______ Approved _____ Disapproved Account Type _____________________

Account Name ______________________________________ New Password __________________________________

Issued by: Received by: Date:

MICHELLE E. ALAGOY _________________________________ ___________________

Information Technology Officer 1 (Printed Name Over Signature)

-- -- -- -- -- -- -- -- -- -- -- -- -- --

Action Taken:
___ Account Created ____ Password Reset ____ Account/Role Modification

Account Name: ____________________________________ New Password: ___________________________

Issued by:

MICHELLE E. ALAGOY
Information Technology Officer 1

Republic of the Philippines Document Code:

Department of Education SDO-KAL-OSDS-ICT-GQF-07
Cordillera Administrative Region Revision: 00
SCHOOLS DIVISION OF KALINGA Effectivity date: 10-01-2018

ACCOUNT REQUEST FORM

Name of Office: ICTS
Date: School ID: Control No.:
2018- __ __- __ __ __ __
Division/Unit/District: School Name:

First Name Middle Initial Last Name User Account (DepEd Email, LIS, EBEIS, EHRIS, etc.)

Nature of Request:
____Account Creation ____Password Reset ______Account/Role Modification
Action Taken: _______ Approved _____ Disapproved Account Type _____________________

Account Name ______________________________________ New Password __________________________________

Issued by: Received by: Date:

MICHELLE E. ALAGOY _________________________________ ___________________

Information Technology Officer 1 (Printed Name Over Signature)

-- -- -- -- -- -- -- -- -- -- -- -- -- --

Action Taken:
___ Account Created ____ Password Reset ____ Account/Role Modification

Account Name: ____________________________________ New Password: ___________________________

Issued by:

MICHELLE E. ALAGOY
Information Technology Officer 1