Blackboard Connect Permission Form

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Bemidji State University
Northwest Technical College
Blackboard Connect
Change of Information Permission Form
I, _________________________, give BSU permission to use the following modes of
(Please Print Name)
electronic contact for emergency notification.
If you’re requesting the Blackboard Connect system to notify you in the event of an
emergency and you would prefer your contact information to be different than what’s
listed on your BSU/NTC portal (i.e. cell phone, home phone, etc.) please complete this
form.
The System will attempt to contact the primary telephone number and email address but
if no answer is received the System will attempt to contact you at a secondary number
and email account.
Primary Telephone Number: _______________________ Cell, Home, Work
(Area Code) (Number)
(Circle one)
Primary Email Account: ___________________________
Additional Phone Numbers to add if no contact is made to your primary number:
Secondary Telephone Number: _____________________ Cell, Home, Work
(Area Code) (Number)
(Circle one)
Secondary Email Account: ___________________________
_______________________ _____________________
(First, Last Name)
Tech I.D.
Faculty or Staff _________
(Circle one)
DATE
Please print and forward completed form to, Information Technology Services, Box #26
The Connect-ED system is only used for purposes of emergency communication and the information
provided will not be sold or used for marketing or any purpose other than emergency communications.
Rev.5-15-2015
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