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					                                   Access to University held Electronic Resources
                                                Authorization Form

   Requestor Information:                                          Account Owner Information:

   Name: ____________________________________                      Name: ____________________________________

   Title:     ____________________________________                 Title:   ____________________________________

   Dept:      ____________________________________                 Dept:    ____________________________________

   Phone: ____________________________________                     Pawprint: __________________________________


The account owner is currently unavailable to grant access for the following reason:

            ____   No longer employed/enrolled/volunteering at the University
            ____   Deceased
            ____   Other _______________________________________________________


Are there adverse circumstances (disciplinary action, suspected misconduct, etc) related to this request?
_____ Yes          ______ No          ______Don’t know
Is there a pending grievance or pending litigation associated with this circumstance?
____ Yes            _____ No          ______ Don’t know

Describe specifically why access is needed:




Please grant the following individuals access to the listed resource(s). Access will be used only for the specific reason
described above.

     Exchange Mailbox                                      Grant Access to:
          _____ Inbox access only                          Name: ___________________________________
              _____ All Mailbox Folders                    Pawprint: _____________________
      _____ File Storage Resources                         Grant Access to:
                                                           Name: ___________________________________
               Please specify location(s):
                                                           Pawprint: _____________________
             ___________________________________
                                                           Grant Access to:
     _____ University owned Personal Computer              Name: ___________________________________
                                                           Pawprint: _____________________
     _____ Other                                           Grant Access to:
                                                           Name: ___________________________________
                ______________________________
                                                           Pawprint: _____________________




Revised 3/2009
                               Access to University held Electronic Resources
                                            Authorization Form




                                           REQUIRED SIGNATURES




                                           For Access To Student Accounts:



        _______________________________________            ______________________________       _____________
        Requestor                                          Print Name                             Date


        ______________________________________             ______________________________       _____________
        Vice Chancellor for Student Affairs                Print Name                              Date


         Once signed submit form to: Division of IT - Information Security and Account Management (ISAM)



                         For Access To Employee/Consultant/Guest/Volunteer Accounts:

        Department Approval:


        _______________________________________            ______________________________       _____________
        Requestor                                          Print Name                             Date


        _______________________________________            ______________________________       _____________
        Division/Department Head or Dean                   Print Name                             Date


         Once signed submit form to: Division of IT - Information Security and Account Management (ISAM)



        Administrative Approval (For ISAM Use Only):


        _______________________________________            ______________________________       _____________
        Chief Information Officer                          Print Name                             Date


        _______________________________________            ______________________________       _____________
        Executive* Approval (or delegate)                  Print Name                             Date

        *MU: Provost or Chancellor
         UMHC: Chief Executive Officer
         UM: Vice President or President




Revised 3/2009

				
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