Brown University Graduate School
Box 1867  x3-2600  Graduate_School@brown.edu
Graduate School Systems
Request for Access to  Graduate School Information Management (GSIM)
SECTION 1: User Information
Name:
Phone No.:
Username:
Box No.:
Brown ID Number: (9 digit from Brown Card)
Status:
Staff
Faculty
Department Name:
SECTION 2: General Information (optional)
Please indicate what the user needs to do using the selected system that is the basis for this request:
If more space is needed, please attach supporting documents. If there is an existing user who currently has the access
you require, enter their name here:
SECTION 3: GSIM Access by Graduate Program
For:
Create New
Change Existing
Delete
For some programs you may have different access, if so please list them there. If you have questions please contact the
Graduate School (contact information above). Enter the requested Programs here:
Add
Remove
Degree/Program
Student Access
View
Current as of: 07/17/2012
Graduate School Access form and directions
Modify
Appointment Access
View
Create
Form #
Approve
GS01
SECTION 4: Policy Acceptance
Password Policy has been reviewed and accepted
[see www.brown.edu/cis/policy/password.html ]
Acceptable Use Policy has been reviewed and accepted
[see www.brown.edu/cis/policy/aup.html ]
The GSIM system includes the ability to attach advisors to students. A student advisor will have access to
confidential student academic and personal information, such as transcripts, grades, test scores, directory
information, etc. via the Banner Self-Service advisor module. It is critically important the each person identified
as an advisor be cognizant that the information that they will be able to access electronically is highly sensitive
and protected under FERPA (Family Educational Rights and Privacy Act of1976) and all measures should be
taken to safeguard this information from public view. Again, due to the highly sensitive nature of the information
that can accessed those who are indicated on this form must have a 'legitimate educational interest' such as a
designated concentration advisor, departmental chairperson, or department administrator responsible for the
clearing of degree requirements.
By Checking this box and initialing here I have read and agree to the above statement
Initial:__________
SECTION 5: Authorized Signatures
User Signature:
Print
Signature
Date
Print
Signature
Date
Print
Signature
Date
Print
Signature
Date
Supervisor Signature:
DGS Signature:
OR
Dept Chair Signature:
For official use only:
Banner ID:
GSIM Access completed by:
Date: _______/______/______
Notes:
Current as of: 07/17/2012
Graduate School Access form and directions
Form #
GS01
Box 1867  x3-2600  Graduate_School@brown.edu
Directions for Completing the GSIM Access Form:
Section 1: User Information
The following are required fields. PLEASE complete them all.
Name
Please PRINT the user’s name, middle initial (if one exists), and last name.
Phone No.
Enter your internal Brown phone extension or complete external phone number.
Username
This is the logon ID whose access is being requested. (e.g. jsmith)
Box No.
Please include your Brown box number.
Brown ID
Number
This is the nine digit number listed on your Brown ID (NOT your social security number).
Status
Check box that describes the relationship of the user to Brown. Note that Students cannot be
granted access to GSIM
Dept. Name
Include the official name of your department.
Section 2: General Information
Indicate what the user will be doing with the requested access. Please be specific enough to assist in determining
what access is appropriate for the user. Please be sure to complete this information in order that access can be
approved.
Section 3: GSIM Access
GSIM Access
Select the functions (create, change, or delete) which reflect the action(s) the user requests. NOTE: Asking for
someone’s access to be deleted will remove all GSIM functionality for that user.
Student Access Levels
 View Access means that the User will only be able to see Graduate Students and all relevant information in

that Program. The final appointment that is pushed to Banner is visible with this role.
Modify Access means that the User will be able to enter and edit Academic information (Progress Evaluations,
Academic Events and Advisors) and enter projected appointments for that Program. The final appointment
that is pushed to Banner is visible with this role.
Appointment Access Levels



View means that the user can see detailed in-progress and final appointment information for that program.
Create means that the user can create/modify appointments for that program and also open and submit drafts
created by other users who can create for that program.
Approve means the user can approve appointments created by others for that program/department.
Section 4: Policy Acceptance
All members of the Brown community who use its computing and network services are obligated to be familiar with
those policies regulating their access and use. This is especially true for those handling sensitive and/or confidential
information. Indicate in the provided spaces that you have reviewed and agree to the listed policies.
Section 5: Authorized Signatures
The person requesting this account and his/her supervisor should sign and date this form. If the supervisor is the
Chair or DGS no further signatures are required. If not than either the Chair or DGS should sign. All signatures
must be original and in ink. If your supervisor is the Program DGS or Chair they can sign in the appropriate line.
Questions?
If you have questions about filling out this form, please email Graduate_School@brown.edu with a subject line of
“GSIM Access question”
Current as of: 07/17/2012
Graduate School Access form and directions
Form #
GS01