Elizabeth City State University | Information Technology
IT User Account Request
This form is used to request new or additional IT user account(s).
 New Account – currently doesn’t have any of the accounts listed
 Additional Account Needed – currently has account listed but needs additional account
 Modify Module Access – additional access is needed to current or additional module(s)
Important Notice
 No access will be given without a completed form.
 For Finance access, contact the Finance MSA* to schedule training, prior to completing form.
 Email and phone requests for access will be denied.
Instructions
1. Requestor completes and signs the appropriate forms.
Account Type
Forms to Complete
Banner (INB), RMS, SQL, WebFOCUS
 IT User Account Request Form
 Confidentiality Security Agreement
VPN
 IT User Account Request Form
 Confidentiality Security Agreement
 Virtual Private Network/System Remote Access User Security Agreement
Domain Account Only
Departmental/Program Email
 IT User Account Request Form
 Confidentiality Security Agreement
2. Supervisor signs the IT User Account Request Form (all account types) and/or Virtual Private
Network/System Remote Access User Security Agreement (VPN only).
If requesting access to RMS, SQL, VPN, Domain Account Only, Departmental/Program
Email, go to step 4. If requesting access to Banner or WebFOCUS, proceed to step 3.
3. New Banner or WebFOCUS account(s) ONLY: Submit forms (i.e. IT User Account Request
Form and Confidentiality Security Agreement) to the appropriate MSA for the module that you
are requesting access to.
o
o
The MSA will complete the Banner Access Authorization Form, and then forward this form to other MSA, if
necessary. The last MSA will then submit all forms to Administrative Computing.
If you need additional access or updates, contact the appropriate MSA.
 Admissions MSA – Admissions Office – Darius Eure
 Advancement/Alumni MSA – Advancement Office – Lucretia Banks
 Finance MSA – Business and Finance Office – Patty Stoddard
 Financial Aid MSA – Financial Aid Office – Latonya Gregory
 Human Resources MSA – Human Resources Office – Tanisha Brumsey
 Student MSA – Registrar’s Office – Mable Riddick
 Student Accounts MSA – Business and Finance Office – Patty Stoddard
4. Submit completed forms to Administrative Computing - ITC - Room 225.
User will be contacted when account is created.
*MSA: Module Security Administrator
Elizabeth City State University | Information Technology
IT User Account Request
Forms must be completed electronically except for signatures.
Forms with hand written corrections, white outs or missing signatures will not be accepted.
User Information
Last Name:____________________________________________ First Name:____________________________________________ M.I.____
Department: ___________________________________________Email:_____________________________________Phone:______________
New Account
Additional Account Needed
Employment Status
Modify Module Access - DO NOT COMPLETE FORM
(Contact appropriate Module Security Administrator)
Account Type
Employee (Permanent)
Employee (Temporary)
*Contract end date: ____________________
Student Worker (Temporary)
*Contract end date: ____________________
3rd party - Consultant/Contractor
Company: _____________________________
*Contract end date:____________________
* Account access will expire after 90 days if no contract end
date is provided
Banner (INB)
RMS
SQL
VPN
WebFOCUS
Domain Account Only (no email)
Departmental/Program/3rd Party Email
Preferred email address
_____________________________@ecsu.edu
Other_________________________________
Module Access
Admissions
Advancement
Finance
Create requisitions
Financial Manager
Alternate Approver
Financial Aid
General
Human Resources
Student
Student Accounts
Provide a brief justification and functions to be performed (e.g. check student registration status, run reports, etc).
For Finance only: Please list the Fund Codes for which you are requesting access.
By signing this form, I state I have read and agree to abide by the policies outlined therein the Confidentiality Security
Agreement and Virtual Private Network/System Remote Access User Security Agreement.
Print Name:_______________________________________Signature:______________________________________ Date: ______________
ECSU Supervisor/Sponsoring Department Authorization
I approve the access requested by the above employee, consultant/contractor. This access is appropriate for the user to properly
perform the duties required as documented in their position description. If the duties for the user of the above computing account
change or the user leaves this department, I will notify IT so that access may be altered or the account may be removed.
Print Name:_______________________________________Signature:______________________________________ Date: ______________
Module Security Administrators Only
Training completed: __Y __N Date:
Module:
Training completed: __Y __N Date:
Module:
Signature:
Date:
Signature:
Date:
Comments:
Comments:
Information Technology Use Only
Username Assigned:
Temporary Password:
Account Type Granted:
Databases: __PROD __TEST __COAS __Other______
Completed by:
Date:
Username Assigned:
Temporary Password:
Account Type Granted:
Databases: __PROD __TEST __COAS __Other______
Completed by:
Date:
Username Assigned:
Temporary Password:
Account Type Granted:
Databases: __PROD __TEST __COAS __Other______
Completed by:
Date:
Up to date Anti-virus software installed ___Y ___N Personal Firewall ___Y ___N
User Privilege Granted: ____HTML user ____ Analytical User ____ Developer
Comments:
IT Ticket #:
Revised 1/17/2014
cdd
Elizabeth City State University | Information Technology
Confidentiality Security Agreement
I, _________________________________________ as an affiliate of ELIZABETH CITY STATE UNIVERSITY agree to adhere
to the COMPUTER USE POLICY and the following procedures related to information security and confidentiality. I
understand my responsibility of trust and agree to perform my job utilizing the security procedures of the
University below: Security and confidentiality is a concern of all University employees. As a user of any ECSU
database or application system you have access to confidential material and are expected to adhere to the security
regulations stated below:
1. All information processed through any ECSU database or application system is considered sensitive and/or
confidential. This information is governed by university policy. The responsibility for determining the release
or discussion of data is assigned to specific individuals in each office. Access to information is based on a
legitimate "need to know" and directly related to my assigned duties within the university.
2. University computers will be used for authorized purposes only. I understand that I am responsible for the
security of whatever data I retrieve.
3. I will report to my supervisor any security violation as soon as I become aware of it.
4. I will provide all necessary safeguards to all confidential information or software in my possession. I will not
copy licensed software or use it except in accordance with established procedures or agreements, nor will I
assist others to do so. When in doubt, I will confer with my supervisor.
5. Where I have responsibilities for the reproduction, destruction, or modification of information, I will be sure
to research and follow all established procedures governing these responsibilities before taking any action.
When in doubt, I will confer with my supervisor.
6. I understand that if granted access, I am to restrict my retrieval and other computing activities only to
information I have been specifically permitted to access as related to my assigned duties and using only
functions and utilities which I have been authorized and trained to use. This includes use of ALL
application software and screens.
7. I understand that any sign-on or password instructions issued are for my exclusive use and are not to be
shared with or delegated to others and that I am responsible for its security.
8. Passwords will expire after forty-five (45) days and users will have to submit a request for a new password.
9. I understand that information disclosed or acquired by reason of my employment at Elizabeth City State
University may be confidential, and I agree not to disclose any confidential information, data, or access, or
security codes at any time during or after employment.
YOU MAY NOT:
 Share your password(s) with another person.
 Permit anyone to access to your account(s) under your password.
 Allow an individual access to your computer when you are logged on any ECSU database or application
system. Each individual must have their own password and access.
 Seek personal benefit or allow others to benefit personally from the knowledge of any confidential
information that you have or they have acquired through work assignments.
 Exhibit or divulge the contents of any record or report to any person, except in the conduct of your work
assignment and in accordance with University policies and procedures and Federal and State regulations.
 Knowingly include, or cause to be included, a false, inaccurate, or misleading entry in any report or file.
 Knowingly delete or cause to be deleted a data entry from any record, report or file except in the conduct of
your work assignment.
Signatures must be original, no stamps or “signed for”. Please do not initial. All signatures must be
handwritten. Electronic signatures will not be accepted.
I certify that I have completed this request fully and accurately to the best of my knowledge. I have read and agree
to comply with the policies and procedures concerning the usage of the ECSU Information Systems. I understand
that access to these systems is to conduct official university business and that the information that is available to
me is not for personal or commercial purposes. I further understand that violation of this policy will result in
immediate removal of my access privileges and may result in additional administrative or legal action, including but
not limited to the possibility of termination of my employment at ELIZABETH CITY STATE UNIVERSITY.
Last 4 SSN: ________________ Department: ____________________________________________Work Phone:__________
_______________________________________
User’s Signature
____________________________________________
Printed Name
____________
Date
Elizabeth City State University | Information Technology
Virtual Private Network/System Remote Access User Security Agreement
Purpose and Scope: I, ______________________________, understand I am being granted permission to remotely
access the IT systems as specified below, and that my use of this access may be monitored by ECSU for compliance
with this policy. This agreement will be renewed semi-annually. I hereby attest that I have read and understand the
ECSU Computer Use Policies for remote access and password management. I agree to comply with these policies,
and I understand that my failure to comply with these policies may result in termination of my remote access
privileges and/or disciplinary action. ECSU will notify users of changes to these policies.
Protection of Data: I hereby affirm and acknowledge my responsibility to ensure the confidentiality, integrity, and
availability of all forms of University information in accordance with ECSU IT Security Policy and the ECSU Security
Manual, in a manner consistent with its sensitivity.
Protection and Maintenance of Equipment :



In the case of remote access via ECSU-owned equipment, I will not alter the configuration of State
equipment unless authorized in writing to do so. I will protect ECSU-owned/ furnished resources and
submit the equipment for periodic maintenance as required by ECSU.
In the case of remote access via equipment owned by another organization, I will verify that the organization
has implemented suitable anti-virus software and firewalls. The organization is responsible for periodic
software and security maintenance.
In the case of remote access via personally-owned equipment, ECSU may provide software installation disks
and support software used to process ECSU information as permitted by software license agreements. I will
abide by the license agreements for ECSU-furnished software. ECSU authorizes me to use my personallyowned computer for remote access, and although ECSU may provide limited support, it is not required to
support maintenance of the hardware or personally-owned software.
Computer Incidents: I acknowledge the possibility, however small, that State information could potentially be
viewed or downloaded by someone other than myself as a result of my remote access. I fully understand that it is
my duty to exercise due care in protecting this information and to immediately report an unauthorized disclosure or
compromise to my supervisor, and to Administrative Computing and Network Services so that appropriate
procedures may be initiated. I further understand that, after proper coordination with law enforcement authorities,
the University may temporarily seize the device used to gain remote access for the purposes of forensic examination
and sanitizing of compromised information. Additionally, during this process I understand that there exists a risk
that system files and programs may be erased or damaged, or that unintentional damage may occur to the
computer hard drive.
Acknowledgment: Remote Access to the ECSU network is a privilege. I hereby acknowledge that remote access is
authorized for my use only and that all passwords and user names are to be kept confidential at all times. By
requesting a remote access account, I acknowledge that I will install or already have installed virus protection
software on my remote (this includes business, home or laptop) system. In addition, I authorize ECSU to perform
random port scans to assess the security when needed of my connection to the ECSU network. Installation of the
virus protection and applying virus signature updates is my responsibility.
_______________________________________
Remote User’s Signature
____________________________________________
Printed Name
____________
Date
I hereby certify that this (circle one) State employee/contractor/collaborator requires remote access as described
herein to accomplish the ECSU mission.
_______________________________________
Supervisor / Division Head Signature
____________________________________________
Printed Name
____________
Date