FILL OUT FORM ON-LINE & PRINT
Information Technology Department
IT Department Fax x6312
FILL OUT FORM ON-LINE & PRINT
IT Department Fax x6312
REQUEST FOR STUDENT WORKER
ACCOUNT
Request Date:
Hand Printed Forms Will Not Be Accepted
Student Worker Network Rights Will Expire at the End of Every Semester & Summer
(Name and Z# of responsible Faculty/Staff member)
Name
First Middle Initial Last
Z# Position Title
Dept: Location: Phone:
Department Head Signature: ______________________________________ Phone:
Type Dept Head Name: Title:
(Student Worker Information)
Name
First middle initial last
Student Login Name (Student May Not Change Login Name/Email Address for this semester)
_____________________________________________________________________________________________________________________
If student worker requires Banner, a separate login with Student’s name will be created. It will
expire at the end of the semester. If no screens are specified, an account will not be created.
Banner Screen F/P/R Type of Access
I understand that the access I am requesting may contain information that is protected by the Family Education Rights and Privacy Act.
(FERPA). I also understand that disclosure to unauthorized parties is a violation of FERPA. When accessing the Banner system, I must only
access information needed to complete my assigned task. This information may only be communicated to authorized parties in accordance
with the provisions of FERPA.
I agree to maintain the confidentiality of my password and to use my access to ORU information for authorized purposes only.
Student
Signature: _________________________________________________ Date: ___________________
_________________FOR INFORMATION TECHNOLOGY DEPARTMENT USE ONLY____________________
Ticket # ___________ Dept. Container:__________________________ Expire Date: _______________
Banner User ID: ___Student Login Name_______ Banner Password: __________________________
Completed by IT: ______________, ____________________
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
