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Data Access Authorization Request Form

You must fill this form out BEFORE you print it. Thank you.

FOAPAL information (Contact Kent Gates x1114 with questions):

*Your CCRI ID# is the 8-digit number below your name on your Faculty/Staff or Student ID.

**Student accounts are terminated at the end of the current semester.

Remember! You must fill this form out BEFORE you print it. Thank you.

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 will be activated upon completion of all training.

Employee's Signature: _______________________________________  Date: _________________

Supervisor's Signature: ______________________________________  Date: _________________

Office Use Only

Enter class, role access or folder if applicable:

Access to: Test  Production

Data Access Officer Signature: _______________________________________  Date: ______________

IT Dept. Completion Date and Initials: _________________