McCormick ITLG55 Access Request Form

McCormick IT

LG55 Access Request Form

Requestor Information

Name*

Phone Number*

Phone

Email Address*

Employee/Student ID #*

NetID*

Position Title*

Position Type*

Faculty

Staff

Student

Other

Other Position Type*

Department*

Principal Investigator (Approver)*

Access Request

Expected length of access period*

One Year

Limited period

Limited period (From ~ To ~):*

Note: Unless specified, access will expire in one year. You must re-apply for access prior to the expiration date to ensure laps in access do not occur.

I am requesting access to the following servers:*

Enter Name and Rack Location

Do you have another server to request access to?*

Yes

No

I am requesting access to the following servers:*

Enter Name and Rack Location

Do you have another server to request access to?*

Yes

No

I am requesting access to the following servers:*

Enter Name and Rack Location

Do you have another server to request access to?*

Yes

No

I am requesting access to the following servers:*

Enter Name and Rack Location

Do you have another server to request access to?*

Yes

No

I am requesting access to the following servers:*

Enter Name and Rack Location

Do you have another server to request access to?*

Yes

No

I am requesting access to the following servers:*

Enter Name and Rack Location

Other Equipment / Systems:*

Enter Other Equipment or Systems

Reason for Access Request*

Please describe the work to be performed

User Responsibilities and Appropriate Use of Access Agreement

As a condition of my being granted access to LG55 and authorization to handle the servers, equipment, and systems specified, I agree to follow the user responsibilities outlined in the link below:

https://www.mccormick.northwestern.edu/it-resources/computer-software/shared-cluster-computing-room.html#LG55

By submitting the form, you acknowledge that you will abide by these conditions that govern access to secure information technology resources at McCormick.

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