third party data access request form
Information Services and Technology
THIRD PARTY DATA ACCESS REQUEST FORM
To: Chief Information Officer, Information Services and Technology
Subject: Request for access to a third party’s computer data
I hereby request access to the University of Manitoba computer account or data of (please print):
Name of account owner ____________________________________________________________
This person is/was a ☐ Student ☐ Employee ☐ Guest
ID Number, if known ______________________ Department ____________________________
Your relationship to account owner ___________________________________________________
(example: colleague, relative, student, supervisor, etc.)
I request this access for the following purpose(s): _______________________________________
________________________________________________________________________________
________________________________________________________________________________
Access Requested
(please be specific; attach a separate sheet if needed)
Username and System(s), if known: ___________________________________________________
Type of Data: email _________ files _________ (Please indicate file names, directory locations, or descriptions)
Duration of Access: ______________________________________________________________
Other Information: _______________________________________________________________
Data Ownership:
I understand that the University of Manitoba deems the rightful owner of computer data to be the person whose username is prefixed to the data. I understand also that the owner’s authorization is normally required before releasing data to a third party. I attest that it is not possible for me to obtain a signature from the data owner for the following reason:
____________________________________________________________________________
____________________________________________________________________________
Responsibility:
I attest that to the best of my knowledge the owner of the data would not have objected to my request and that I am not aware of any other issue of confidentiality or ownership that might be breached by the access that I am requesting. I accept full responsibility for requesting this data and for maintaining confidentiality of contents respecting FIPPA.
Requestor’s Name (please print): _______________________________ Phone: ______________
Email Address: ___________________________________________________________________
Address or Department: ____________________________________________________________
________________________________________________________________________________
Signature: ____________________________________________ Date: ______________________
Approval by Head of Unit or Faculty of Data Owner
Name (please print): _______________________________ Faculty or Unit: _________________
Signature: _________________________________________ Date: _________________________
Return To: Computer Accounts Administrator
Information Services & Technology, 123 Fletcher Argue Bldg Office Use Only
Telephone: (204) 474-9788 Fax: (204) 474-7920
Email: computer_accounts@umanitoba.ca
Received: __________________ Initial: ________
May 19, 2015 Page 1 of 2
OFFICE USE ONLY (entire page)
Account Owner’s Name:
__________________________________________________
Requestor’s Name:
______________________________________________________
Request Date:
__________________________________________________________
☐ Approved
Comments:
☐ Declined
CIO on behalf of VP Admin:
Signature: _____________________________________ Date: ____________________
Access granted to the third party:
ccu (
☐
email only
☐
full ) cns __ ins __ exchange __ office 365 __ office workstation __
List any special access rights held by this account. These privileges should normally be removed by the system administrator before giving access to the third party. If not, please give a reason. ccu service class: _________________________________________________
☐
Removed ccu groups: _____________________________________________________
☐
Removed cns admin rights: __________________________________________________
☐
Removed ins admin rights: __________________________________________________
☐
Removed
exchange admin rights: _____________________________________________ ☐ Removed
office 365 admin rights: _____________________________________________
☐
Removed
Processed By: _____________________________________ Date: ________________________
May 19, 2015 Page 2 of 2
