Texas PDM Request for Access Rights to E-Grants System

E-GRANTS USER INFORMATION New User Re-activation Date:

Last Name: First Name:

Company/Agency:

Position Title:

Mailing Address:

City: State: ZIP Code:

Daytime Phone: Alternate Phone: Fax Number:

Email Address: ACCESS RIGHTS Indicate level of access rights below:

View/Print Level

For individuals who only need to view and print the application

Create/Edit Level

For individuals who will be creating and editing the application

 Includes View/Print Level Rights Sign/Submit Level

This is limited to individuals who have the authority to commit the Sub-applicant for the required funding of 25% local match and submit the application to the state

 Includes View/Print and Create/Edit Level Rights Are you the Primary Point of Contact? Yes No

The Primary Point of Contact must have Create/Edit Access Level Rights or higher AUTHORIZATION Must be signed by a Judge, Mayor or agency head to designate which individuals are granted access and their level of access rights

Signature: Date:

Position Title: This request form must be filled out in its entirety, signed by the designated official, scanned, and emailed to either Eileen Whitaker at [email protected] or Christy King at [email protected]

Texas Division of Emergency Management Texas PDM – Request for Access Rights to e-Grants System Form # TDEM-16 / Revision 04-24-14