NEOMIN  
Account Application
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Please complete, print & include signatures
Fax or mail to NEOMIN for processing
528 Educational Hwy, Warren OH 44484
FAX: 330 847-8568   PH: 330 847-6464

Name: Work Phone Number/Ext. E-mail: 
Your job title: Your district: Your building:

Select services you need:
ESIS - See your district ESIS Coord Fiscal Applications/Remote PO * District Email Administration
Email - See your Technology Coord EMIS State Data * District Proxy Administration

Select distribution lists PERTINENT to your job :
Adult Education Athletic Directors Attendance Officers
Business Office Curriculum Directors EMIS Coordinators
Fiscal Services GED Test Administrators Guidance Counselors
INFOhio / SIRSI Users Maintenance Personnel Principals
School Board Members SchoolNet Special Education
Student Services Superintendents Teachers
Technology Coordinators Test Coordinators Transportation Personnel
Vocational Education    
* indicates you also need to fill out the EMIS/Fiscal authorization form
The NEOMIN systems to which your account has access should be used exclusively for district related business. It is understood that misuse of your account can lead to the temporary or permanent loss of system access. Any loss of data or costs resulting from the misuse of these privileges will be the responsibility of the school district or company requesting these privileges. NEOMIN reserves the right to reject requested privileges where sufficient need is not demonstrated as well as the right to suspend use of the account for reasons of misuse or for system maintenance. Please review the NEOMIN policies before signing this form. By signing this form you are stating that you have read & consent to the referenced NEOMIN policies & that you have signed an Acceptable Use Policy at the district level.

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Name Printed  (Job title if you chose "other" )
  
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Your Signature & Date

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Supervisor's Name Printed
  
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Supervisor's Signature & Date

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NEOMIN Executive Director
  
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Superintendent/Authorized Employee's Signature/Date