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MSBA SYSTEM ACCESS REQUEST FORM <br />OPM REPORT SYSTEM USER <br />PLEASE PRINT CLEARLY. <br />TODAY'S DATE: <br />TITLE: <br />NAME: <br />E -MAIL ADDRESS: <br />ADDRESS: <br />DISTRICT NAME: <br />SYSTEM ACCESS REQUESTED: <br />OPM REPORT SYSTEM SCHOOLS FOR WHICH ACCESS IS REQUESTED (Please List) <br />r OPM Firm (Update) <br />r OPM Firm (Read Only) <br />r District Staff (Read Only) <br />I, , the Superintendent of Schools or Mayor/Town Administrator for the <br />Town/City/Regional School District of hereby authorize the above -named individual to access and use <br />the MSBA online database as requested above, with the level(s) of access indicated. I understand that, should the above -named <br />individual be granted access to this database, he /she will be solely responsible for access to the database on behalf of the <br />Town /City/Regional School District of , using the login ID and password provided by the <br />MSBA. <br />Signed: <br />Superintendent of Schools/Mayor/Town Administrator <br />MSBA Use Only <br />APPROVED BY: <br />COMPLETED BY: <br />DATE <br />DATE <br />Please fax completed form to either Paul Fowkes or, for the Green Repair Program, William Cross at the MSBA: <br />PHONE: <br />CITY: <br />ZIP: <br />617 - 720 -5260 or 617 - 720 -8460 <br />