Vacation-Sick Leave Privilege Request Form by hijuney9

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									                 Vacation-Sick Leave Record System
             Request for Privilege Change (Revised November 2005)
REQUESTOR:
Request made by: ______________________________________ Date: __________
                          (Last)                    (First)
Department (Name and Number): _________________________________________
Campus Address: ______________________________________________________
Phone: _________________ E-mail: ______________________________________

PERSON NEEDING ACCESS:                     New         Change           Transfer to Dept: _______
Full Name: ___________________________________________________________
                          (Last)                    (First)                        (Middle)
Career Account Alias: ___________________ Position Code: __________________
Department (Name and Number): _________________________________________
Campus Address: ______________________________________________________
Phone: _________________ E-mail: ______________________________________
Change privilege level to:           Viewer          Administrator          SuperAdmin
   Permanent            Temporary (effective until:_______________________________ )
Justification (explain why this person needs the requested level change):




The access and privileges granted will be used for business purposes only. Sensitive or restricted data
will not be maintained in the VSL system. I accept this responsibility in accordance with Executive
Memorandum No. C-34 <http://www.purdue.edu/policies/pages/information_technology/c_34.html>.
_____________________________________________________ Date: __________
(Applicant Signature)


CREATE DEPARTMENT (complete only if a new department needs to be added to VSL):
Department Name: _____________________________________________________
Department Number: ___________________________________________________
Business Office Name: __________________________________________________
Department Home Web Page: http://________________________________________
Primary Administrator: __________________________________________________

APPROVAL SIGNATURES:
Dept Head:___________________________________________ Date: ___________
Dept. Business Office: __________________________________ Date: ___________
Send completed form to Tonya Byrd, AGBO AGAD, Phone: 49-48515, Fax: 49-61104, tonya@purdue.edu

								
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