First Name:

Last Name:

Exit Date:

Department:

Location:

Floor:

Manager:

Laptop

Yes /  No

 PDA

Yes /  No

Docking Station

Yes /  No

Did the departing employee have any special network access (circle all that apply):

• Unicare
• Great Plains
• Raiser’s edge
• Ohio Scales
• Other: ____________________________

Underlined and bolded options represent defaults

Disable and give access to the following user(s):  Direct Manager &

1. Disable without forwarding function
2. Leave email address active and forward all new mail to the following BAPC address:

If email is being left active and forwarded please provide select a time frame to disable the account:  30 Days___  60 Days___  90 Days___  Other:___________________________

Do you want the departing employee’s H drive information copied to your H Drive?

Yes:

No:

By default the voice mail will be deleted once IT is notified of the employee’s departure and the extension will be set-up to go to the automated staff directory.  If you need access to the voice mail and/or need the number forwarded please select from the following options.

Give the following user access to the departing employee’s voice mail:

Forward the departing employee’s number to the following extension:

If voice mail is being left active or extension is forwarded please provide select a time frame to disable the extension:  30 Days___  60 Days___  90 Days___  Other: _________