UREG: Registrar's Office at the University of Virginia
   

Request for Access Form

Employee Name: Mainframe ID:

HR Employee ID: (Example: HR Employee ID Example) Phone: E-mail ID:

Department: Department Address:

Action requested (check one): Create mainframe ID: Delete ID: Modify ID:
System Requested (A=Add, C=Change, R=Remove):

Requirement for ISIS/IW access: Completion of Information Technology Security Awareness training test
and Electronic Access Agreement. Must send a copy of the Certificate of Completion and signed Electronic Access Agreement with request form.

ISIS (Integrated Student Information System)

Purpose:

IW (Information Warehouse): Contact Information Warehouse for Information
Please check the Information Warehouse Data needed below
Student Data: Check list below FAS

Student Directory Only

Facilities Management

Undergrad Restricted

 OSP (Contact OSP for prior approval)

Graduate Restricted

 Bursar

All Students Restricted

 Finanical Aid
VATs:

Other/Comments:

Supervisor's Signature: ___________________________________________________

Please complete and return this form by messenger mail or fax to:
Debra Shiflett, Academic Data Security Contact
Office of the University Registrar
PO Box 400203, Carruthers Hall
e-mail: dcs9v@virginia.edu
Tel: 434/924-4130, Fax: 434/982-2627
________________________________________________________________________
For Office Use:
Key:________________________ Submitted: _________________ Approved: __________