Ohio Department of Education Portal Authentication Sign-up, identity form

Ohio Department of Education - Secure Web Portal Identity Form
Please use this form and the process detailed below to request a secure Web account from the Ohio Department of Education. The rigorous identity authentication process is required in order to reduce the risk of Internet criminals gaining access to secure ODE computer systems. Once the identity authentication and authorization process is complete, secure ODE Portal account owners can digitally sign documents and access secure systems (based on personalized permissions) using that account. These digital signatures are recognized under the Ohio Revised Code. Click here for details regarding ORC and digital, or electronic signatures.
In order to verify or "authenticate" your identity, the ODE requires the following:
Step 1: Click the "printer version" button at the top right of this Web page and print the page.
Step 2: Place your valid State Driver's License or Identification Card in the space provided below (adhesive tape is helpful).
Step 3: With your valid State Driver's License or Identification Card attached, make a copy of the form.
Step 4: With a black marker, remove all but the last 4 digits of your Social Security Number on the copy of this form, if it appears on the copied license.
Step 5: Complete the Email address, IRN (if applicable), Web application to which you want authorization, First name, Last name, Date of Birth, Last 4 SSN, and contact phone number fields on the form below, along with your signature.
Step 6: Fax the completed form to the ODE Security Administrator 614-387-0973
Please print your email address below:

Please print IRN of School District or Building (if applicable):

Please select Application:

__AYP
__Byrd Scholarship
__CORE
__FLICS
__GED
__Head Start
__OEDS
__Preschool Units
__SFPS

Please print your first name below:

Please print your last name below:

Please print the last 4 digits of your SSN below:

Please print your date of birth below: (mm/dd/yyyy)

Please print your contact phone number below:

Place your valid State Driver's License or Identification Card here
(adhesive tape is helpful),
copy, and fax the signed, completed copy to the
ODE Security Administrator:
614-387-0973

I have read the ODE Secure Web
Portal document at: https://safe.ode.state.oh.us/portal/signup/
and I fully agree to the terms and conditions.

______________________________________
(form is not complete without a signature on line above)