Systems Design New Installation Form

Systems Design New Installation Form
School District Name *
County-District Number *
TDA Contracting Number *
Street Address *
City *
State *
Zip Code *
Name of Installation Contact *
Installation Contact's Phone Number *

Area Code Phone Number
Installation Contact's Email *
example@example.com
Name of Child Nutrition Director *
Child Nutrition Directors Phone Number *

Area Code Phone Number
Child Nutrition Directors Email *
example@example.com
Name/Contact to Appear on State Reimbursement Claim *
We are a CEP district *

Yes No
We are a Provision 2 District *

Yes No
Name/Contact to Appear on Benefits Letters
Name/Contact Information of Hearing Official and Title
Tell Us About Your CEP Campuses

All Campuses Are CEP Not All Campuses Are CEP
Name/Contact Information of Technology Director
Please List All Campuses and Campus Numbers
All Campus Listed Above are Severe Need

Yes No
List All Campuses that are Severe Need
Static IP Address Assigned to the Food Service Server *
Network Subnet Mask *
Gateway IP Address for Server *
Indicate the Type of Remote Connection to be used *

Secure Shell VPN (Cisco, Microsoft, Other) Telnet or Other Internet Connection
Static IP Address for the Main POS System Printer *
The Point of Sale Terminals Will Have IP Addresses That Are *

Assigned Dynamically Use static IP addresses
List of Campuses and IP Addresses Equal to the Number of POS Terminals at Each Campus
Static IP Addresses for the Campus Printers *
Does Your District Serve Breakfast in the Classroom

Yes No
Do You Plan to Use ID Cards

Yes No
Please Select and Upload the District Logo

Browse Files

Cancel of
Does Your District Serve After School Snacks

Yes No
Will You Elect to Display the Student's Picture on the Touchscreen

Yes No
Your Desired Install Date *

Month Day Year
Your Comments or Questions
Should be Empty: