IDMS Access Form

Updated: 05/22/2013

http://www.miami.edu/uam/idmsaccess/

University of Miami | Information Technology | IDMS Access Form

REQUESTING ACCESS FOR:

( one form per application requested )

Application: Data Custodian:

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AUTHORIZED SYSTEM USER AGREEMENT

The use of this I.D. number or information obtained using this system by Persons Not authorized may result in violation of the Family Education Rights And Privacy Act (Buckley Amendment) and other confidentiality provisions of State and Federal law and can lead to disciplinary sanctions which may include dismissal from the University. I have read, understand and agree to abide by the University of Miami Policies (A040, A045, A046, A047).


Signature: ___________________________________________	Date: / /

REQUESTOR INFORMATION

First name:

M/I:

Last name:

Job title:

ID #: - -

Campus bldg:

Room #:

Locator code:

Department:	Phone #: - -
E-mail address:

TO BE COMPLETED BY DEPARTMENT ADMINISTRATOR
Computer charge account no:	Today's date: / /

Authorized signature: _______________________________	Print name: _______________________________

TO BE COMPLETED BY DATA CUSTODIAN

Data custodian approval: _____________________________________________________

Profile: _______________________________________________________________________

Comment: _____________________________________ Today's date: _____/_____/_____

FOR INFORMATION TECHNOLOGY USE ONLY

User-id: __________________________________

Request completed by: _________________________ Today's date: _____/_____/_____

Comment: _____________________________________________________________________