Banner Student Authorization Request Form

[print version]

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

Return to:

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   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: _________________