State of Louisiana Office of Telecommunications Management
Telecommunications Coordinator (TC) Appointment/Update Form (OTM-11)
New Telecommunications Coordinator Appointment Request (Check all appropriate items)
Include access to the OTM bill on-line (web billing)
I am interested in Telecommunications Coordinator Orientation
Telecommunications Coordinator Information Update (Check all appropriate items)
The information below should be corrected for the current TC
The TC listed below should be deleted
The TC listed below should be deleted from web billing
Mr.
Ms.
Dr.
Other
(specify)
Name
LEO Personnel ID or Last Four
Digits of Social Security Number
Title
Department
Office
Section
Address
City
State
Louisiana
Zip
Telephone
Fax
Email
Authority
(agency wide, statewide, etc.)
Responsible for
Voice
Data
Voice and Data
List all OTM cost center numbers under new TC's authority ( separate sheet attached)
This TC is authorized on behalf of the cost centers listed here to make changes and additions for telecommunications
equipment and services and to obligate related funds.
Signature of Appointing Authority
Printed Name of Appointing Authority
Title of Appointing Authority
Signature of Newly Appointed TC
Date
RETURN TO: OTM Information and Training Section
PO Box 94280
Baton Rouge, LA 70804-9280
Fax 225-342-7810
Rev. 02/07