STOCKTON UNIVERSITY
101 VERA KING FARRIS DRIVE
GALLOWAY, NJ 08205-9441
UNIVERSITY AFFILIATE
ENTITLEMENT REQUEST FORM
SECTION 2a
For the following section, refer to the information
provided here as reference.
The Management Entity will select from the choices in Section 2a that represents the division,
department or organization that they are authorized for the approval of University Affiliates.
Section 2a continues on the next page
Administration and Finance (A&F)
Accounts Payable
Procurements & Contracts
Budget & Fiscal Planning
Payroll
Bursar’s Office Procurements & Contracts
Personnel, Labor & Government Relations (PLGR)
Human Resources
Mailroom
Office of Institutional Diversity and Equity
Nation Aviation Research & Technology Park (NARTP)
Pensions & Benefits
Facilities and Operations (FAO)
Department of Facilities Management & Plant Operations
Campus Police Custodial
Department of Facilities Planning & Construction
Stockton Affiliated Services Incorporated (SASI)
Bookstore
Campus Bank
Food Services Transportation Vending
A&F
PLGR
Management Entity / Sponsor Information
Authorizer Name
Authorizer Stockton Phone Number
Authorizer Title
Authorizer Stockton Email Address
SECTION 2
To be completed by Stockton
Management Entity/Sponsor
Applicant Signature ____________________________________________________________________ Date _______________________________________
Authorizer Signature ____________________________________________________________________ Date _______________________________________
Emergency Contact Information
Permanent/Home, Business/Work, Personal Cell, Parent/Gaurdian
For the following section, refer to the
information provided here as reference.
Phone Type:
Sibling, Child, Parent, Doctor, Relative, Spouse, Ex-Spouse, Friend, Gaurdian,
In-Law, Neighbor, Domestic Partner, Significant Other, Advisor/Sponsor, Embassy
Relationship
to Applicant:
Relationship to Applicant
Emergency Contact Last Name Emergency Contact First Name
MI
Apt./Unit # City
County ZIP/Postal Code Country (if not United States)
Emergency Contact Phone Type Emergency Contact Email Address (optional)
Emergency Contact Permanent Street Address
State/Province
Emergency Contact Phone Number
Have you ever been a student or employee of Stockton before?
2. Z-Number
2a. Username
or STK#
2b. What was your
previous role?
Z
Student Prospespective Student (applicant) StaffFaculty
Vendor Contractor
Food Services
Press VolunteerPresenter/Performer
If you have ever been issued a Z or STK number, username or PIN, or vendor ID,
please fill out this section.
Birthdate 1. Ethnicity 1a. (if Caucasian)
Not Hispanic/LatinoHispanic/Latino
Gender
M F
________________
Biographical Information
AA = Black/African American, AI = American Indian/Alaskan Native, AS = Asian,
CA = Caucasian/White, HW = Native Hawaiian or Other Pacific Islander
For the following section, refer to the information
provided here as reference for Question 1.
Ethnicity:
UNIVERSITY AFFILIATE
ENTITLEMENT REQUEST FORM
Last Name
First Name
Prefix
Personal Identification and Information
SECTION 1
To be completed by the
University Affiliate Applicant
MI
Suffix
Apt./Unit # CityStreet Address
County Country (if not United States)State/Province ZIP/Postal Code
Personal Email AddressPrimary Phone Number Primary Phone Type
Primary Vehicle Make Primary Vehicle Model Primary Vehicle Lic. Plate #
S.S.N. (last 4 only)
If Applicant will be parking a vehicle in Stockton
lots/garages, please complete the following fields
University Affiliate Entitlement Request Form | v3.1 01/27/2020 | Office of Information Security | information.security@stockton.edu
OFFICE OF INFORMATION SECURITY USE ONLY
SECTION 3
To be completed by the
University Office of
Information Security
Attibute 2 (ATYP)
Expiration
Attibute 1 (MGMT)
Attibute 3 (ITAC)
Third Party IDZ-Number
Z
Lock Access Required
Network
Yes No
IT Entitlements
ID Card Required
Email
INB Banner Print
Lab
@stockton
Create Account C
WiFi
Academic
BlackBoard G SuiteLibrary
@go.stockton
BW
SECTION 2b
Remote
VDI VPN
A work order must be placed with the University Lock Shop. Work through the sponsoring Management Entity for all physical access requests.
SCAN AND RETURN TO: information.security@stockton.edu
Yes No
SECTION 2a (cont.)
For the following section, refer to the information
provided here as reference.
The Management Entity will select from the choices in Section 2a that represents the division,
department or organization that they are authorized for the approval of University Affiliates.
STUD
Academic Affairs (ACAD)
Academic Advising
Honors Program
Office of Research & Sponsored Programs
Institute for Faculty Development
Bursar’s Office Student Records/Registrar
School of Arts and Humanities (ARHU)
School of Arts and Humanities
ACAD
School of Business (BSNS)
School of Business
School of Education (EDUC)
School of Education
School of General Studies (GENS)
School of General Studies
Office of Global Engagement
School of Graduate and Continuing Studies (GRAD)
School of Graduate and Continuing Studies
School of Health Sciences (HLSC)
School of Health Sciences Clinical Facility
Holocaust Research Center (HRC)
Holocaust Research Center
Richard E. Bjork Library (LIB)
Richard E. Bjork Library
School of Natural and Mathematical Sciences (NAMS)
School of Natural and Mathematical Sciences
Performing Arts Center (PAC)
Performing Arts Center
Satellite Campus (SAT)
Hammonton Campus Manahawkin Campus
School of Social and Behavioral Sciences (SOBL)
School of Social and Behavioral Sciences
Southern Regional Institue and Educational Technology Training Center (SRI)
Southern Regional Institue and Educational Technology Training Center
Atlantic City Operations (ACO)
Carnegie Center Dante Dance Hall Theater Noyes Art Garage
Atlantic City Campus
Champions of Youth
Nacote
Student Affairs (STUD)
Career Center
Educational Opportunity Fund
Vice President for Student Affairs
CARE
Dean of Students Office Enrollment Management
Residential Life (RESLIFE)
Residential Life
Counseling, Community Wellness, and Community Health Education (WELL)
Counseling, Community Wellness, and Community Health Education
Athletics (ATHLETE)
Office of Athletics and Recreation
Campus Center Operations (CC)
Event Services and Campus Center Operations Free To Be
Learning Access
Student Development
President’s Office (OPR)
Institutional Diversity and Equity Institutional Research and Planning
Foundation Board
Graphics Production
Fiscal Affairs
Hughes Center (HUGHES)
Hughes Center
Information Technology Services (ITS)
Information Technology Services
University Relations & Marketing (URM)
University Relations & Marketing Print Services
Board of Trustees (BOT)
Board of Trustees
OPR
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