The Department of Digital Learning
2014-2015
2014-2015 DIGITAL CITIZENSHIP Verification Form
The Federal Communications Commission (FCC) outlines Children's Internet Protection Act
(CIPA) requirements. Under this law, Fort Bend Independent School District’s (FBISD) Digital
Citizenship Document requires all FBISD Students to view a Digital Citizenship video.
Once all students on your campus have viewed their grade‐level’s video (as verified by campus
administrators), please utilize one of the following submission options and submit your campus’
form to, Mary Connealy (Administrative Assistant to the Director of Digital Learning):
• Electronically submit the form (by scanning and submitting as an electronic mail attachment)
• Fax the form to: 281-327-1099
• Return the form via inter‐district mail
If you are sending your form via electronic mail, please use the following subject line:
“YOUR CAMPUS’ NAME: Digital Citizenship Verification Form”
Form must be received by: October 17, 2014
By signing below, you are verifying that all students on your campus viewed the mandatory
Digital Citizenship video for their grade level.
Campus: _________________________________
Date: ___________________________________
Principal’s Signature (or Administrative Designee):
_______________________________________
Fort Bend Independent School District Administrative Annex
3119 Sweetwater Blvd Sugar Land, TX 77479