DNCU Network Access Authorization Form
NNMC System Access Authorization Form CHECK ONE FORMCHECKBOX Establish Employee Start Date: FORMCHECKBOX Modify EmployeeChange Date: FORMCHECKBOX Inactivate EmployeeInactivate Date: EMPLOYEE INFORMATIONPrint Name: Banner ID:Department: Title:Supervisor: Contact Phone:Email: IT Department/Network ResponsibilitiesCheck all that apply: FORMCHECKBOX Banner ID: FORMCHECKBOX Broadcast/Faculty/Staff list: FORMCHECKBOX Email Address: FORMCHECKBOX Banner eMail (GOAEMAL): FORMCHECKBOX Active Directory Access (NNMC Network): FORMCHECKBOX Regroup Emergency Notification Software: FORMCHECKBOX Web Directory: FORMCHECKBOX CoNetrix Vendor Management Software: FORMCHECKBOX Shortel Phone System/Communicator: FORMCHECKBOX Copiers: FORMCHECKBOX Computer/Phone Equipment: FORMCHECKBOX Remote Access to the NNMC Network (VPN): FORMCHECKBOX WASP Inventory System: FORMCHECKBOX Sharepoint Access: FORMCHECKBOX Other: FORMCHECKBOX Banner Self-Service Access (PEAEMPL)Request for SELF-SERVICE BUDGET INFORMATION ACCESS MENU to view the following accounts : Department Name FUND(XXXXX) ORG (XXXX)Special Instructions or Notes: Banner Access: Print Name:Approved by: Signature: I agree that the employee has an academic/administrative need to access Banner Self-Service. I will notify the Banner Security Administrator in writing should the employee resign, transfer or be terminated, or the need for this access no longer exists.For IT use only:Assigned To:Date:Signature:Completed on: ................
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