Fillable Admin Acess RequestForm September2019

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Admin Acess RequestForm September2019

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Administrator Access Request
for Faculty & Support Technicians (Group of Computers)
InformationTechnology @ CCSU Revised 5/2017 Page 1 of 2
Use this form to request an administrator account for a group of computers. Return both pages of this
form to the Information Technology Department, located in Marcus White Hall, Room 006. Alternately,
you may fax it to us at 860-832-1730. When the account has been created, you will be notified.
Employee Name
Employee Job Title
Department
Employee Phone/E-mail
Supervisor
Date of Application
Group administrative rights being requested (provide information in appropriate field):
Department
Name:
Classroom(s):
List of computer
names:
Employee Acknowledgement
I have read and understand CCSU’s Administrator Access for Faculty & Support Technicians Policy. I
agree to abide by it as consideration for continued employment by CCSU. I understand that violation of
any of the stated policies may result in my termination.
___________________________________
Employee Name
___________________________________ _____________________________
Employee Signature Signature Date
Supervisor Approval
I approve the request for administrative rights as outlined above.
___________________________________
Supervisor Name
___________________________________ _____________________________
Supervisor Signature Signature Date
Administrator Access Request
for Faculty & Support Technicians (Group of Computers)
InformationTechnology @ CCSU Revised 5/2017 Page 2 of 2
IT Approval
This section is for IT Department administrative purposes only.
The request has been: ___ Approved ___ Denied
If the request has been denied, please document the reason for denial.
If the request has been approved, please document the following information:
Planning Activation Date
Actual Activation Date
___________________________________
IT Authority Name
___________________________________ _____________________________
IT Authority Signature Signature Date
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Admin Acess RequestForm September2019

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Completed 16 February 2020

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