eLearning User Account Form Use this form for all eLearning user
account additions, deletions or changes to
the reporting administrator designation.
Instructions This form should be used for all eLearning user
additions, deletions or changes to the reporting administrator
designation. For your convenience, this is a fillable form that can
be easily populated on your computer. Submit forms via email to
TxDMV‐[email protected]. The number of eLearning user accounts
provided at state expense is based on the number of TxDMV‐issued
workstations. Each TxDMV‐issued workstation is entitled to one
eLearning user account, which represents a county’s Base Accounts.
Counties with 1‐19 workstations will receive one additional
eLearning account, and counties with 20 or more workstations will
receive an additional 10% eLearning accounts, which represents a
county’s Additional Accounts.
Base Accounts + Additional Accounts = Total Accounts at State
Expense Counties with more than the Total Accounts at State Expense
will be required to pay $9 for each additional eLearning
account.
Please note the following information when submitting this
form:
• Complete applicable sections (except for the Tabulation
section) and submit via email to TxDMV‐[email protected].• The
signature at the bottom of the page serves as the county’s
acceptance of any account fees owed.• We will make the requested
edits and complete the Tabulation Section.• We will send you a
confirmation email that includes any account fees owed (any fees
incurred will be invoiced the following fiscal year).
Contact Information County County Contact Name
Email Address Phone Number Cell Phone Number
This information will be provided in your Tabulation of
eLearning User Accounts at State Expense and Account Fees Owed
confirmation email. Base Accounts Current # of workstations
Additional Accounts Total Accounts Base + Additional
Current # of eLearning Accounts
Net Adds (Deletes)
per this request
Ending # of eLearning Accounts
# of Accounts Above (Below) Total Accounts
Account Fee Owed $9 x # of Accounts Above
Total Accounts 1‐19 workstations = 1 additional
20+ workstations = 10% additional
Email addresses serve as eLearning account user names. If a user
needs an email address assigned, please leave the Email field
blank, check the Create Email box, Add Users and we will populate
the Email field for that user. First Name Last Name RTS User ID
Email this will be the eLearning account user name
Create Email
Total User Accounts Added Delete Users If the deleted user is no
longer employed by the county, please include the last date of
employment.
First Name Last Name RTS User ID Last Date of Employment Email
(user name)
Total User Accounts Deleted Reporting Administrator
Designation
First Name Last Name Email (user name) Add Designation
Remove
Designation
I have the authority on behalf of County to approve any
eLearning Account Fees Owed.
Printed Name / Title
eLearning User Account Form
Signature Date
Rev 11/20
County: County Contact Name: Email Address: Phone Number: Cell
Phone Number: Base Accounts Current of workstationsRow1: Current of
eLearning AccountsRow1: Net Adds Deletes per this requestRow1:
Ending of eLearning AccountsRow1: of Accounts Above Below Total
AccountsRow1: Account Fee Owed 9 x of Accounts Above Total
AccountsRow1: First NameRow1: Last NameRow1: RTS User IDRow1: Email
this will be the eLearning account user nameRow1: First NameRow2:
Last NameRow2: RTS User IDRow2: Email this will be the eLearning
account user nameRow2: First NameRow3: Last NameRow3: RTS User
IDRow3: Email this will be the eLearning account user nameRow3:
First NameRow4: Last NameRow4: RTS User IDRow4: Email this will be
the eLearning account user nameRow4: First NameRow5: Last NameRow5:
RTS User IDRow5: Email this will be the eLearning account user
nameRow5: First NameRow6: Last NameRow6: RTS User IDRow6: Email
this will be the eLearning account user nameRow6: Create EmailTotal
User Accounts Added: First NameRow1_2: Last NameRow1_2: RTS User
IDRow1_2: Last Date of EmploymentRow1: Email user nameRow1: First
NameRow2_2: Last NameRow2_2: RTS User IDRow2_2: Last Date of
EmploymentRow2: Email user nameRow2: First NameRow3_2: Last
NameRow3_2: RTS User IDRow3_2: Last Date of EmploymentRow3: Email
user nameRow3: First NameRow4_2: Last NameRow4_2: RTS User
IDRow4_2: Last Date of EmploymentRow4: Email user nameRow4: First
NameRow5_2: Last NameRow5_2: RTS User IDRow5_2: Last Date of
EmploymentRow5: Email user nameRow5: Total User Accounts Deleted:
First NameRow1_3: Last NameRow1_3: Email user nameRow1_2: First
NameRow2_3: Last NameRow2_3: Email user nameRow2_2: I have the
authority on behalf of: Printed Name Title: Date: Add'l Accounts
(1-19 workstations): Add'l Accounts (20+ workstations): Total
Accounts: Check Box3: 0: Off1: Off2: Off3: Off4: 0: Off1: Off
Check Box4: 0: 0: 0: 0: Off1: Off
1: 0: Off1: Off
