Banner Human Resources Authorization Request Form

Please complete the top of the form online then print the form to obtain the necessary signatures.

Return to: Robin Donnelly, Human Resources, Knight Campus, Room 3118

Please provide the following information:

Date:

CCRI ID:

First, MI, Last Name:

*Title:

*Please indicate if you work through a Temp Agency

Department:

Campus:

Phone Extension:

E-mail:

Employee Role:

Faculty Staff Other

If Intern / Volunteer:

Date Begin: Date End:

Account Type:

New Terminated Change

If account changed, what is reason?

Agreement: I have read, understood, and agree to comply with FERPA regulations, the CCRI Data Security Policy and the CCRI Policy on the Responsible use of Information Technology; I understand that I am responsible for any computing activity carried out using this account. Access to Banner Human Resources will be activated upon completion of all training.

Applicant's Signature: _____________________________ Date:_________________

Supervisor's Signature: _____________________________ Date:_________________

For Office Use Only

Module: _________________ User Role No.: _________________

Access to: Test Production

Data Access Office Signature: _________________ Date: _________________

IT Dept. Completion Date and Initials: _________________

Community College of Rhode Island

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Banner Human Resources Authorization Request Form