Sample Teacher Statement of Provision of Student Access to the Internet

I have reviewed the school's Acceptable Use Policy with students registered in the course and course section below prior to authorizing their access to networked information resources within my instructional program. I have received confirmation from the principal that all students in this course and section, with the exception of those listed below, have supplied a signed "Permission Form for Student Access to the School's Internet Connection."

Students listed below are not authorized for Internet access.


Signed ______________________________ Date _____________________


Course Name _________________________ Section ___________________