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Community College of Rhode Island

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Banner Student Authorization Request Form

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

Return to:

  • Stacey Flowers, Flanagan Campus for CWCE
  • Melissa Braun, Flanagan Campus for Student Affairs and all other departments
Please provide the following information:
First, MI, Last Name:
*Please indicate if you work through a Temp Agency
Phone Extension:
Employee Role:
 Faculty  Staff   Student Help Intern / Volunteer
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 Student 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: _________________

Last Updated: 2/20/15