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VPN Request Form
Bowie State University
Last revised: 04/13/2018
The Requestor must have a Bowie State Network account.
1. Requestor (Remote User) - Please fill out this form completely. Incomplete forms will be
returned and fulfillment of your request will be delayed. Forward the completed form as an email
attachment to your Authorizing Supervisor for their approval.
2. Authorizing Supervisor (Sponsor) if you approve, forward this completed form as an
attachment to with subject as VPN Request Form.
3. Helpdesk Support Team Create ticket for IT Security Team, category: Security. Remote
Access, unassigned, and attach this form to the ticket for their review.
4. IT Security Team Review ticket and approve or disapprove access. Forward approved tickets
to Systems Engineering Team for execution.
5. Systems Engineering Team Check that ticket has VPN form and enough information, add
the user to the SSL VPN remote access group, and close the ticket.
1. Contact Information
The Company and Affiliation sections need only be filled in for remote users who are not part of the
Bowie State University. The Sponsor must be a member of the Bowie State University and should be at
the manager, director, or department head level.
Requestor (Remote User)
Authorizing Supervisor (Sponsor)
Access Until:
Note: For temporary VPN access, Sponsor should please specify end date in
Access Until
form will not be processed.
2. Purpose of the Remote Access (To be completed by Requestor)
Please answer the following questions about the purpose and criticality of the remote access you have
What is your Bowie State account name.
This is usually your Bowie State Network ID
and your email address.
Please describe in general terms the
purpose of this remote access, or the
activities to be performed.
Does this activity support official business
functions of your department?
Is this activity critical to your department?
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Are there feasible alternatives to remote
access to achieve the same goals?
Are the functions to be performed part of
the remote user’s official job role?
3. Systems/Applications to be Accessed
Please fill in a row for each system that will be directly accessed by the remote user. Add additional rows
if you need them. Provide the details to items listed below of the system you are trying to remote into.
IP Address
System Owner
Approval Granted?
4. Remote Device Security Requirements - Disclosure (To be completed by
Bowie State security policy, in conformance to the USM IT Security Standards, sets minimum security
criteria for all PCs that attach to Bowie State networks.
Please answer the following questions regarding the security of the device (e.g. laptop, desktop, etc.) you
will be using to connect to the Bowie State University network.
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5. Account Sponsor Statement of Acceptance (For Sponsor Only)
The information provided in this request form is accurate to the best of my knowledge. I understand that
providing access to remote users and devices exposes Bowie State to certain security risks. I accept
responsibility for the risks imposed by the remote users I sponsor. I agree to notify the Bowie State’s IT
Security Team when this account is no longer needed so that the remote access can be disabled. I will
also notify IT Security Team if I become aware of any security problems or threats related to this remote
Sponsor Signature ____________________________________ Date _____________________