Tennessee Technological University
Advancement Informaon Systems and Resources Request Form
Access to Advancement Informaon Systems and Resources systems is a privilege. Individuals with a work-
related need for access to the informaon contained in these systems may be granted such privilege based on a
qualied request submied. By requesng access and subming a signed request form, all users are agreeing
to abide by all Tennessee Tech policies specically 801—Informaon Technology Acceptable Use, 802—Access
Control and 851—Informaon Security Roles and Responsibilies.
First Name
MI
Last Name
Phone Number Campus Box
Department
Title
Email
T Number
Please describe the purpose for desiring access:
As the applicant’s supervisor, I recommend approval of the above applicant for access to the requested Advancement Infor-
maon System and/or Resource. I agree to nofy the Execuve Director of University Advancement of any change in this
individual’s employment status or job responsibilies that would warrant a change in access privileges.
Supervisor Signature Date
Applicant Signature Date
To be completed by University Advancement
Acons taken/by whom/date: