SIS SECURITY ADD/CHANGE/DELETE FORM
EMPLOYEE NAME
EMPLID
DEPARTMENT
ADD/CHANGE/DELETE
DATE NEEDED
PHONE
EMAIL
SIS COPY ID
(Contact SIS Security Admin for listing of SIS Copy
IDs and roles)
REASON FOR REQUEST/SECURITY (Required)
EMPLOYEE STATUS
Please check box that applies.
Full-time Faculty
Full-time Staff
Faculty Advisor
Part-Time Staff
Adjunct Faculty
HRMS Self Service: Add Delete
HRMS Manager Self Service
(Attach Security Tree) Add Delete
AIS Security (Attach form) Add Delete
Employee Signature: _______________________________________ Date: ____________________
Supervisor Signature: _______________________________________ Date: ____________________
Data Owner Signature: _______________________________________ Date: ____________________
Personal information collected is safeguarded in compliance with the laws of the Commonwealth of Virginia and federal law as stated in the Family
Education Rights and Privacy Act (FERPA). By signing this form, you agree to not divulge any information obtained through the SIS system to
unauthorized persons or organizations.
Revised 2/11/2020
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