Pasco County Schools Final Intern Access Form

To be completed by Final Intern requesting access to our systems.

University Supervisor University Supervisor First Last
University Name
Intern Name Intern Name First Middle Last
Name must match EXACTLY as shown on Social Security card.
Assigned Pasco County School Location (School-Based)

If assigned multiple locations, select "Multiple Locations" and specify locations in comments below.
If you aren't an education major, please select the specialized program/department within Pasco County Schools you are interning with:
Are you a final intern?

Are you a final intern? Yes No
Start Date - End Date

Indicate the duration of the contracted services to be provided by this employee.
Social Security Number

Number must match EXACTLY as shown on Social Security card.
Date of Birth
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Citizenship Status
Gender
Marital status
In order to comply with government reporting requirements, the District School Board of Pasco County invites employees to voluntarily and confidentially self-identify their race and ethnicity. Submission of the following information is voluntary and the refusal to provide it will not subject you to any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws. When reported, data will not identify any specific individual.
RACE (check all that apply):

RACE (check all that apply): American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White or Caucasian Decline to Identify

In order to comply with government reporting requirements, the District School Board of Pasco County invites employees to voluntarily and confidentially self-identify their race and ethnicity. If the employee volunteers this information, please include below. Refusal to provide will not result in any adverse treatment. The information will be kept confidential and will only be used in accordance with the provisions of applicable laws. When reported, data will not identify any specific individual.
Are you Hispanic or Latino? (“Hispanic or Latino,” is defined to mean a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.)
Comments and/or Additional Information:
To be completed by Pasco County Schools
Comments from HREQ to Hiring Manager.

Pasco County Schools Final Intern Access Form

Pasco County Schools Final Intern Access Form

To be completed by Pasco County Schools