Access Request Form for Administrative Systems

Name: __________________________________________
SSN: __________________________________________
Job Title: __________________________________________
Job Status
(Circle One):
        Faculty                 Staff                 Student
Office Phone: __________________________________________
Department: __________________________________________
K-State eID: __________________________________________

Type of Access Requested:
____   New
____   Change
____   Additional Access
____   Delete

Please print this form, read the following, sign and date the form, then give it to your supervisor to indicate the access needed.

System Security:     I understand that security dictates I do not allow any other person to know or use my password, and that should it become known and used by someone other than me I will change my password. Further, I understand that should I allow another person to use my userid and password I will be discontinued as a registered terminal operator.

FERPA Law:     You are expected to comply with federal law (FERPA 1974) regarding the privacy of student information. Your responsibilities are defined in KSU's Student Records Policy (Registrar's Office).

Applicant Signature:     _______________________________ Date:________

Supervisor Signature:   _______________________________ Date:________

Dept. Head Signature: _______________________________ Date:________


Request Access to System(s)

Circle I for Inquiry, U for Update, or check for Access-DARS only):
  I   U   SIS/ADM - Student Information System--Undergraduate Admissions
  I   U   SIS/REG - Student Information System--Student Records
  I   U   BRS - Billing Receivables System
  I   U   FRS - Financial Records System
  I   U   SFA - Student Financial Aid System  
  I   U   OTHER - ______________________________(Specify)

  ____    DARS - Degree Audit Report System (Client version, Dean's Office Only)


If Update selected, explain:
  _____________________
  _____________________
  _____________________
  _____________________

Send Completed form to:
    Security Administration
    iTAC
214 Hale Library
    Kansas State University

If you have any questions regarding completion of this form please contact the ISO Helpdesk at 532-7722.