Microsoft IT Academy - New Member Registration Form

Thanks for your interest in Microsoft IT Academy! For new member registration, please complete all fields marked with red text. All other fields are optional.

A separate survey needs to be completed for each library location/branch that participates in the IT Academy. This allows a unique identifier to be assigned to that location. IT Academy staff will then have a better ability to provide support and also statistics on the use and benefit of the IT Academy.

Location Information

Please provide information for the library location/branch.

A separate survey must be completed for each library location/branch that will participate in the IT Academy program. Each location/branch will be registered and assigned a unique identifier.

If you list a PO Box for the location, please make sure the street address is listed as the first/primary address (Address 1) and the PO Box is listed as (Address 2 or 3).

Question Title

Library Type

Public

Two-Year Academic

Tribal

WSL

Question Title

Library Information

System Name:

Branch Name (if applicable):

Address 1:

Address 2:

Address 3:

City:

Zip:

Program Administrator Contact

An administrative contact must be assigned for each location/branch. Two approaches exist: 1) assign a single centralized contact to manage the project for all locations/branches; 2) assign a different project manager for each location/branch.

The Program Administrator should be the library staff person that will lead the Microsoft IT Academy project for your library. Responsibilities for this person include:

Coordinating program implementation within the library;
Promoting the program to staff and patrons;
Receiving communications from the IT Academy Program;
Identifying library staff to attend training(s) on the Microsoft IT Academy Program.

Please provide the information requested for the person who will manage the IT Academy Program at your library/branch. Required fields are indicated in red. The Program Administrator can easily be changed and updated. If this should occur there will be an easy update process.

If you list a PO Box for contact, please make sure the street address is listed as the first/primary address (Address 1) and the PO Box is listed as (Address 2 or 3).

Question Title

Our library intends to use:

1) a different program manager for each library location/branch; for each new record and location/branch, enter program manager information for that location.

2) the same program manager for all library locations/branches; enter program manager information for the first record/ library location. For each new survey, mark this option, we will copy program manager information to all locations for the same library.

Question Title

Administrator Information

First Name:

Middle Name:

Last Name:

Title:

Address 1 (if different than above):

Address 2:

Address 3:

City:

State:

Zip:

Phone:

Phone Ext:

Fax:

Email: