Gems Access Request Form
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2GEMS Access Request Form
Please use this form to request access to the secure GEMS site. The secure site gives the user access to
unmasked, student-level data for the school or district for the indicated access area. District access includes
all schools within the district. Once the district’s Authorized Representative has signed this form, you can
scan and email it to
, mail it to OPI Security Desk, P.O. Box 202501, Helena, MT
opigemshelpdesk@mt.gov
59620-2501 or fax to 406-444-1369.
If you need to look up your LE number, SC Number or who your Authorized Representative is, go to the
School Directory on the OPI Reporting Center under ‘Public Reports’:
https://apps.opi.mt.gov/OPIReportingCenter/frmDefault.aspx?ReturnUrl=%2fopireportingcenter.
County Name: _________________________________________________
LEA/Organization Name: _______________________________________ LE Number: ___________________
School Name: _________________________________________________ SC Number: ___________________
Full Name: ___________________________________________________
Email: _______________________________________________________ Phone: ________________________
GEMS Access Area: (check or circle all that apply)
□ Achievement □ Free and Reduced Lunch □ Enrollment □ Special Education
□Career and Technical Education □ College Readiness □ Early Warning System
□ FAFSA (Please complete the FAFSA Completion Initiative on page 2 of this request form)
Job Duties: (check or circle all that apply)
□ District Superintendent
□ District Clerk
□ Principal
□ Other____________________
□ Special Education Director □ Testing Coordinator □ Determining Official
□ Counselor
County Name: _________________________________________________
LEA/Organization Name: _______________________________________ LE Number: ___________________
School Name: _________________________________________________ SC Number: ___________________
Full Name: ___________________________________________________
Email: _______________________________________________________ Phone: ________________________
GEMS Access Area: (check or circle all that apply)
□ Achievement □ Free and Reduced Lunch □ Enrollment □ Special Education
□Career and Technical Education □ College Readiness □ Early Warning System
□ FAFSA (Please complete the FAFSA Completion Initiative on page 2 of this request form)
Job Duties: (check or circle all that apply)
□ District Superintendent
□ District Clerk
□ Principal
□ Other____________________
□ Special Education Director □ Testing Coordinator □ Determining Official
□ Counselor
Authorized Representative must sign below in order to process this form.
With my signature below, I certify the accuracy of the information submitted on this form.
______________________________________________
______________________
Signature of Authorized Representative
Date
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