EMPLOYEE
ACCESS REQUEST FORM
Note: Please complete and sign form, make 3 copies, and submit 1 copy each
to Information Technology, Finance and Facilities at least 5 business days prior to date needed.
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Last name: First name: Middle initial: Start
date:
Classification: Job title: Supervisor:
Location:
Program/Department Building Floor
Needs Keys: Needs
Security Code:
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Finance/PR Allocation
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Cost Center
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Department
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Allocation %
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Technology
Needs
Computer: Desktop Laptop Other If
using existing PC, enter Asset ID#:
Phone/VM: Physical phone 7-digit phone number Extension/VM only
If using
existing phone, enter Asset ID#: If
using existing phone number, enter:
Email: Standard BAPC
None Other email address:
Network Access
List the
staff member whose network permission level you would like to duplicate for
this person (refers to the folders/directories the employee will need to
access):
Additional folders/directories: (List)
Remove access to directories: (List)
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Application Programs
Family Care Equal
to staff person
FRX Equal
to staff person
Great Plains Dynamics Equal
to staff person
Ohio Scales Equal
to staff person
Pure Edge Equal
to staff person
Raiser’s Edge Equal
to staff person
UniCare Equal
to staff person
Other Equal
to staff person
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Agency Tools
Unicare Reports
Read Update Report Delete Admin
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Supervisor
Signature Date
