Bulk Associate Account Request Form

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Associate Account Request Form
In order for us to grant you access to University Information Systems it is necessary for you to supply the following information. All fields are compulsory
and must be filled in block capitals only.
Requesting Company Details:
Company:
Town:
Telephone:
Address:
County:
Fax:
Post Code:
Mobile:
Reason For Association:
Dept. / School:
Association Group:
Contact:
Association:
Create Accounts For:
Name:
Email:
Job Title:
X Number:
Please read the following information carefully and sign below to signify that you have read and understood the conditions that apply to your access.
The University requires that all users of its computer systems abide by its Regulations and the relevant legal requirements concerning such computer access that are embodied in the
University’s Regulations, particularly those relating to the use of its Information Technology Facilities and its Policies relating to Data Protection and Computer Misuse. Users of
University computer systems must preserve the confidentiality and security of University information; such information must not be copied or transferred to alternative media
without express authorisation. Any information accessed must only be used for purposes directly related to the University’s official business. In signing this form you are signifying
your acceptance of these conditions, and any transgression may lead to disciplinary action being instigated by the University. Furthermore, you should note that your use of
University IT Facilities may be monitored and recorded and this information may be used as evidence in any disciplinary or legal proceedings.
Signed by Company Contact
Name:
Signed:
Contact
Number:
Date:
Approved by School Senior Management Team
Signed:
Date:
Print:
Processed by:
Signed:
Date:
Reasons for Association
HEPB Staff:
Association:
HEBP Staff
Overseas partner institution
Cleveland College of Art & Design
Staff
Binary University College
Mediterranean College Athens
Darlington College
Middlesbrough College
Redcar & Cleveland College
Hartlepool College
Stockton Riverside College
Other Staff:
Association:
Visiting Lecturer
Visiting Professor & Fellow
Non-University
Association:
Library Health Alliance Staff
Wilton Client
Visiting Researcher
Digital City Fellow
Lecturer Practitioner
Students' Union Staff
Agency Staff
OOH Helpline
Police Trainer
Non-UoT Teaching Staff
Contractor
Graduate Business Unit member
Consultant