Account Access Form
Employee Information
Employee Name:
Date:
Time:
Employee Number:
Employee’s Phone:
Department:
Location:
Manager’s Name:
Manager’s Phone:
(Manager's signature is required for approval.)
Access Requested
(Please check all network accounts the employee needs access to.)
Is this request for a change to an existing account or for the creation of a new account?
Existing
New
VPN
25 Live
BlackBoard
PeopleSoft
Oracle
Residence Hall
Administrative
Accounting
Dining Services
Access Requested for the following Users for Email Account:
Request for Access to Network Shared folders
By signing this document, I signify that I have read, understand, and agree to abide by the company computer use policy.
Name of Folder (full path e.g. \\savana\accounting) :____________________________________
Name of sub-folder (if any): _________________________________________
Access permissions requested:
Read/Write Read Only Modify
How Long will access be required?
30 Days End of Semester End of Academic Year Other:___________________
For Information Technology Services Use Only
Accounts created by:
Date:
Time:
Notification given by:
Date:
Time:
Please return this form to: Information Technology Services
Once created, all account information will be sent to the applicant. Please allow three business days for account
creation. Direct any questions regarding your application for computer access to Information Technology Services.
Signatures
(The applicant's signature is required.)
By signing this document, I signify that I have read, understand, and agree to abide by the company computer use policy.
Applicant’s Signature _____________________________
Date:____________
Manager’s Signature _____________________________
Date:____________
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