Information Technology
New
User Account Request

 


 Please Type or Print Clearly


New User's Name Employee I.D.#  
Phone   Position/Title  
Division/Department   Manager  

 

Employment Status:

[  ]  Board Member [  ]  Management  [  ]  Classified
[  ]  Full-time Faculty [  ]  Part-time Faculty [  ]  Confidential
[  ]  Full-time Counselor [  ]  Part-time Counselor [  ]  Counseling Intern
[  ]  Full-time Librarian [  ]  Part-time Librarian  
[  ]  Hourly [  ]  Retired Faculty  
[  ]  Contract Education Student:  Start Date:___________   End Date:___________ [  ]  Contractor (specify:                                              )

 

Access:

[   ]  Non-Privileged - E-mail, Internet, Z drive, etc.

[   ]  Privileged - Access to student records as a privileged user in Department/ Division

       Create this user the same as another user (specify existing user name:  __________________________________)

       For privileged access, please fill out a PeopleSoft Security form in addition to this form.

[   ]  Create Windows account
[   ]  Create Rosters+ account (specify department or division:                                                                                     )
[   ]  OnBase user.
Macintosh Only:  [   ]  Create Macintosh volume (Z drive equivalent).  Windows account is required for authentication.

 

 

Dean/Director's Name:        _________________________  Date: _________

 

Dean/Director's Signature: ________________________________________


To be completed by Information Technology:

User Name: __________________   Account: _______   Created By: _______________  Date:  ___________

 

Form Revision Date:  12/16/13