K12USA.com Network Management Services
SecureSchool Signup Information Form
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Red Items are Required
Shipping Information

Name of School:
Street Address:
City:
State/Country:
Zip:
Total Student Enrollment:

Technical Contact (for access to Web-Based Controls)

Full Name:
Phone Number:
E-Mail Address:

Additional Technical Contacts

Full Name:
Phone Number:
E-Mail Address:

Full Name:
Phone Number:
E-Mail Address:

Technical Configuration Information

In order to configure our box to your network settings, we will need additional information from you. If you should require assistance, or if you have any questions please contact toll-free us at 877-225-0100 or via e-mail at info@k12usa.com.


What type of Internet connection do you have? (T1, Cable, DSL, etc):
How many buildings do you have for your school or district?
If you have more than 1 building how many Internet connections do you have?
Approximate number of workstations in your district:

Outside Public IP Address:
Outside Public Subnet Mask:
Outside Public Default Gateway (Assigned by Your ISP):
Note: This must be on the same network as the Outside IP Address.
If your ISP has assigned you to use DHCP for your Outside IP Address, please write DHCP in the above boxes.

Inside IP Address:
Inside Subnet Mask:

Are you keeping your existing Proxy server?
Yes No
If No, we suggest using your current Proxy server's IP Address as SecureSchool's inside IP Address.
Additionally, we need to know what Port Number your current Proxy server uses for Internet Proxy requests:

Are you keeping your existing firewall?
Yes No
If Yes, will SecureSchool run in parallel with the firewall?
Yes No
If No, will you have servers on your inside network that will require access from the outside world?
Yes No

Web Server:
Yes No
Public IP Address:
Inside IP Address:
Host Name: (for example: www.k12usa.com)
Email Server:
Yes No
Public IP Address:
Inside IP Address:
Host Name:
What type? (Exchange, OWA, POP/SMTP, etc)
FTP Server:
Yes No
Public IP Address:
Inside IP Address:
Host Name:
Other Server:
Yes No
Public IP Address:
Inside IP Address:
What Type?
Any other comments
you think might be helpful:



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