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Security Access Request Form

After completing, please print and deliver to HR for new employees, or to Computing Services for changes to current employees.

Required fields

User Information

Supervisors, please ensure ALL information is filled out. Failure to do so may result in delays in processing. Some services require 24–48 hours to go into effect.

Requestor
Personal Information
Position
Position Type & Location

Position Type

Location

IT Security Awareness Training Required

The following require IT security awareness training regardless of other access:

Description & Notes

This box expands as you type.

Acceptable Use Policy Agreement

I agree to comply with Paul D. Camp Community College's Acceptable Computer Use Policy for Information Technology Resources.

Type your name to represent your signature on the printed form.

Data Owner Authorization

Supervisors, please select any/all systems to be used by the employee and have the appropriate Data Owners sign.

SIS: Admissions & Records (Use this for instructors.)
SIS: Financial Aid
SIS: Workforce Development
Additional Systems — Operations Manager Authorization

Select all systems this employee will need access to:

For Computing Services Use Only

Supervisors, please do not write in this area.

Account Creation
System Setup Checklist
Added to emergency alert notification system
Access to all college calendars
Notified of self-registration for helpdesk ticket system
SIS / HRMS Access
WES / NELNET Access
Request Tracking
For use by Computing Services only — Date request received

When the print dialog opens, choose Save as PDF as the destination.