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Computer Access Form

  1. NOTE: this form is to be used to authorize the initiation or termination of certain computer access privileges. Upon completion by the affected department, it should be forwarded to the IT department for implementation.

  2. Employee Status*

  3. Is this employee authorized for access to Email?*

  4. Is this employee authorized for access to the Internet?*

  5. Assign card from former employee in this position or get a new card # from IT

  6. Use this field to explain specific access to systems or what to do with employee data post-termination.

  7. Leave This Blank:

  8. This field is not part of the form submission.