University of Wisconsin – Eau Claire
Justification and Authorization for Remote Data Access
Requested by______________________________________________
Employee’s Title________________________________________________
Explain the business purpose requiring remote data access.
(The justification should provide a sound work-related purpose, identifying those job responsibilities you have that
require regular and routine internet access necessary for monitoring infrastructure and maintaining the integrity of
University assets that must be available 24 x 7)
_____________________________________
______________________________________
Employee Signature
Date
I hereby authorize the use of remote data access described above for the purposes stated.
__________________________________
__________________________________
__________________________________
__________________________________
Immediate Supervisor Signature
Associate Vice Chancellor Signature
Date
Date
Director/Dean Signature
Division Administrator Signature
Date
Date
Return completed form to Vickie Gardner – Schofield 104.
Form Updated 9/1/11