DNCU Network Access Authorization Form
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NNMC System Access Authorization Form
CHECK ONE
| |Establish Employee |Start Date: | |
| |Modify Employee |Change Date: | |
| |Inactivate Employee |Inactivate Date: | |
EMPLOYEE INFORMATION
|Print Name: | |Banner ID: | |
|Department: | |Title: | |
|Supervisor: | |Contact Phone: | |
|Email: | |
IT Department/Network Responsibilities
Check all that apply:
| |Banner ID: | |Broadcast/Faculty/Staff list: |
| |Email Address: | |Banner eMail (GOAEMAL): |
| |Active Directory Access (NNMC Network): | |Regroup Emergency Notification Software: |
| |Web Directory: | |CoNetrix Vendor Management Software: |
| |Shortel Phone System/Communicator: | |Copiers: |
| |Computer/Phone Equipment: | |Remote Access to the NNMC Network (VPN): |
| |WASP Inventory System: | |Sharepoint Access: |
| |Other: | |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: |
Approved by: Full Name:
Signature: Print Name:
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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