Community Unit School District No. 1
5:125-E2
Request to Use Non-District Affiliated
Electronic Media Technologies for School Purposes
Employees of Charleston Community Unit School District #1 who wish to create and maintain an official
District or school presence on a non-District-sponsored site must complete this form. This form, along with the
required signed authorizations, must be on file in the building office prior to a site’s activation. A copy of this
form will also be filed with District Technology Director. Once authorized by a school principal, the employee(s)
is/are fully responsible for regular monitoring of the site, appropriate online conduct, and adhering to the
District’s official Personal Technology and Social Media Policy and AUP for Information and Communication
Technologies Access. Personal sites are not acceptable for conducting official district or school business.
Date: __________________________ Building(s): _________________________________________
Employee Name: _____________________________________________________________________
Employee Position: ___________________ E-mail contact: __________________________________
Nature of request:
Website/page: _________________________________________________________________
Blog: _________________________________________________________________________
Other: ________________________________________________________________________
Proposed Launch Date: ____________________ Target Audience: ____________________________
All site age restrictions will be adhered to rigorously.
Purpose of presence on social media site:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
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©2012 Policy Reference Education Subscription Service
Illinois Association of School Boards
Community Unit School District No. 1
5:125-E2
Reason(s) why District-approved communication tools and technologies do not serve your purposes:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
How will this site be administered/monitored to ensure that District policies are followed (i. e. how often
and by whom)?
_____________________________________________________________________________________
______________________________________________________________________
______________________________________________________________________
SITE ACCOUNT INFORMATION:
The District requires full access* to all non-personal** sites associated with District sponsored activities. Are you
willing to give the principal and/or building designee authorization for full access to the requested non-personal
site? Yes______ No _______
Name or URL associated with site: ________________________________________________________
Signature of Requestor: ____________________________________________ Date: ______________
Signature of Co-Requestor: _________________________________________ Date: ______________
AUTHORIZATION BY SCHOOL PRINCIPAL:
Principal Signature: _______________________________________________ Date: ______________
*For example: Facebook has administrative roles for manager, content creator, etc.
** The District does not want access to personal social networking websites and will not ask for passwords to said sites.
ADOPTED: July 17, 2013
5:125-E2
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©2012 Policy Reference Education Subscription Service
Illinois Association of School Boards