To request that a particular web page address be blocked by the iPrism Internet filtering system, please complete and submit the form below. Your request will be immediately e-mailed to the iPrism administrator who will block the site as soon as possible. Your request will also be sent to the "Allow/Disallow" committee members who will evaluate your request to make sure that blocking the site will not prevent other classes from gaining access to valuable educational resources. The site will remain blocked unless you hear otherwise from the committee.

Items marked with a purple * are required.

* Name: * Campus:

Principal's Email Address:

Please include your first and last name in case we need to contact you for additional information or clarification.

Grade Level: (Choose as many as apply.)
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
 7th Grade
8th Grade
 9th Grade
10th Grade
11th Grade
12th Grade
Enter each web address in a separate blank:

* URL: http:// this page only: entire web site:

Rationale:
(offensive language, nudity, advocates violent behavior, other reasons for requesting that the web page(s) be blocked)

URL: http:// this page only: entire web site:

Rationale:
(offensive language, nudity, advocates violent behavior, other reasons for requesting that the web page(s) be blocked)

URL: http:// this page only: entire web site:

Rationale:
(offensive language, nudity, advocates violent behavior, other reasons for requesting that the web page(s) be blocked)

URL: http:// this page only: entire web site:

Rationale:
(offensive language, nudity, advocates violent behavior, other reasons for requesting that the web page(s) be blocked)

URL: http:// this page only: entire web site:

Rationale:
(offensive language, nudity, advocates violent behavior, other reasons for requesting that the web page(s) be blocked)