Departments can use the following template as the basis for their internal database access request forms.

 

​Access Request Form Template
System Name:

Requestor Information
Name:
Employee ID:
Campus Connect ID:
Phone:
Email:
Office Location:
Department:
Job Title:
Supervisor:
Supervisor email:

Access request for (data or role – note here if highly sensitive data is included in this request):

Access request level (read, modify, manage):

Business purpose for access:

Data owner (please print):

Data owner signature and date:

Supervisor signature and date:

Employee certifies that he/she agrees to maintain confidentiality of data in accordance with DePaul’s Access to and Responsible Use of Data Policy and Acceptable Use Policy including protecting his/her password from unauthorized use .

Employee signature and date:​​