Access Rights / Authorization Request

Instructions

Please complete this access authorization request form to obtain role-based access to IT / Information Assets.

Ensure the justification clearly describes why access is required.

User Information

Full Name *

Email Address *

User Role at Time of Request *

Home Organization *

Host / Supervisor *

Supervisor Email *

IT / Information Asset Requiring Access

Type of IT / Information Asset *

IT / Information Asset Name / Identifier *

Asset Owner / Steward *

Asset Owner Email *

Requested Access

Requested Role (RBAC) *

Justification Category *

Access Start Date *

Access End Date *

Justification

Justification for Access *