Designated Campus Colleague (DCC) Request Form

This request form is for occupants of the Phoenix Biomedical Campus for the departments listed in the dropdown. Only authorized requestors will be eligible to submit a request. If you do not know if you are an authorized requestor, please contact HR-PHX@arizona.edu. Your request may be delayed if you provide incorrect or incomplete information. Please ensure your are responsive for any information requests. Requests will be closed after 14 days if no response is received. *Faculty DCC requests, please contact COMPHX-OFAD@arizona.edu. Thank you, UA HR-PHX@arizona.edu

 

Designated Campus Colleague Information

For additional information please visit www.hr.arizona.edu/employees-affiliates/affiliates

 

Please provide your first and last name in the event more information is required to process this request.

 
 
 

Please indicate the correct department for which the DCC will be sponsored within.

 

This individual is responsible for managing their membership in the department and will be responsible for orientation within the unit.

 
 
 
 

Cannot be @email.arizona.edu, @asu.edu, @hotmail.com, @aol.com, or @bannerhealth.com as elevated SPAM and firewalls exist that prevent the University automated emails from delivering

 
 

If this is a research request, please indicate the area of research (ex: cardiology, neurosciences, etc.). in addition to providing a list of duties.

 
 
 

If the indivdual is not a US citizen, you MUST attach a copy of their passport or other appropriate visa documents. If you are unsure, please contact hr-phx@arizona.edu

 

Required Attachments

 

Please attach the resume here. If you answered NO to US citizenship, please attach passport documents here.

Drop your files here
 
 

 

Security-Sensitive Functions

 
 

Protected health information (PHI) includes all individually identifiable health information relating to the past, present or future health status, provision of health care, or payment for health care of/for an individual that is created or received by a Covered Entity or Business Associate. Health information

 
 
 
 

 

Specialized Training- Research Exposure

Additional training may be required by the Office of Research Administration, College of Medicine-Phoenix before granting access to the labs. For more information please visit www.risk.arizona.edu/training.

 
 
 
 
 

In contact with animal tissues, fluids, or waste byproducts in a research setting.

 

 

College of Medicine - Specific Request

 

Clinical teaching includes medical students and residents.

 

I have verified that a signed preceptor agreement is on file with the contracting office or this individual is associate with an institution that has an executed preceptor agreement on behalf of the physician.