Administrative System Access Request

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Date:  Monday, November 28, 2022 Select a Date Delete the Date

Employee Instructions:

  • Take the FERPA tutorial
  • Complete form online
  • Submit form electronically by clicking the Submit button.
  • Print and sign form and send to supervisor for signature

    • If you have questions, contact us at ITSAccess@govst.edu

     
    Employee Name (First and Last Name)  
    Title/Function  
    Unit/Department  
    GSU Email Address (For notification only)  
    Signature (Type first and last name)
     

     IMPORTANT: Please Print and Submit

    By submitting this form, the employee affirms that they have read and understood GSU policies and procedures regarding administrative systems access, and agrees to abide by GSU policies 61, 64, 65, and 71. These policies can be found at GSU Policies Page. GSU systems contain private and confidential information protected by federal (FERPA, HIPAA) and state (IIPA, IPIPA) laws that govern the access by, and disclosure of information to/by persons not specifically authorized by Governors State University. Typing my name in the signature box above constitutes my electronic signature. 

    PRINT the form, and send to your supervisor:   

    SUBMIT the form electronically so that ITS can receive notification:    

      Employee STOP: Only Supervisor below this section. 

    Supervisor Instructions:  

    • Review form, if adjusting, initial next to changes.
    • Sign form, ensure employee also signed.
    • Scan signed form and email to ITSAccess@govst.edu

    GSU ID Number:   (Must be in Colleague before we can process the request)
     Will employee schedule classes in Colleague?
                                                                                                                          
     Faculty MyGSU Portal access? 
            
    Will employee be adding/removing holds?
      2.  
                          

    Will the employee require access to Perceptive Content?
     Name of user with similar rights or employee being replaced (N/A if not applicable)  
     Supervisor Name: (First and Last Name)  
     Supervisor signature (Required, forms not signed cannot be processed)
    _____________________________________

    Supervisor STOP: Only ITS below this section.

    Environment:
    Production________ Test_______ Staging______    		 Faculty Advisor Access: Yes___ No___
    Completed by ________________________ Received date ___/___/20___
    Username assigned __________________________ Completed date ___/___/20___
    Portal Access:
    FAC__  ADV___ ADV-RO__    		 Notified ___/___/20___

     This form replaces all previous versions. Revised 18 October 2022.