Access Request Form

Requestor Information

Please input all necessary fields.

Today's Date*

Input today’s date

Requestor's Name*

First Last

Title*

Department*

Phone extension*

Email*

Will You Be Removing Account Access?*

Please select if account access will be removed from an employee, vendor, consultant etc.

NO

YES

Account Designation

Please select account designation*

Select the user account designation. For example will the user be designated as Administrator, CAST, Classified, Full-Time Faculty,Part-Time Faculty/Adjunct, Short-Term/Hourly Employee, Student Employee, Vendor/Consultant or Microsoft 365 Guest.

Microsoft 365 Guest

Company Name*

Guest Sponsor*

Guest Information*

First Middle Last

Guest Email*

Team Name to Add Guest

End Date*

Account Access Information

Please select one of the following that apply*

Add Access to new employee

Change Access to a Current Employee

Move Employee to a different Job Assignment

Name Change

Employee Information

Select Management Category For The Department*

Please select management that will be overseeing the employee(Superintendent, Vice President, Dean, Department Chair, Director, Supervisor, Manager)

First and Last Name of Management*

Please provide the name of Department Management overseeing the employee.

First Last

Employee Name*

Please provide legal name from Human Resource

First Last

Employee Name (Previous Name)*

Please provide previous legal name as provided to Human Resource.

First Last

Employee ID Number*

Please input valid employee ID number

Title of Employee*

Input official title as provided by Human Resources

Email

Input email. Please provide email of department management, if employee does not have Palomar Email. This is a required field.

Phone Extension*

Input Phone Extension. Please provide phone extension of department management, if employee does not have a personal extension. This is a required field.

Department of Employee*

List the department the user is designated to as provided by Human Resources

Office Location of Employee*

Office location or building number. Input NA if employee will be working remotely.

Employee Start Date*

Access Removals, Consultants, vendors, short-term/temporary and student employees tend to have a start date of contract upon hire.

Employee End Date*

Access removals, consultants, vendors, short-term/temporary and student employees tend to have an end date/termination date of contract upon hire.

Upload Short Term, Student Employee, Vendor/Consultant Proof of Employment*

Please submit the current most Short-Term, Student employee action form or vendor contract.

Drop files here or

Max. file size: 49 MB.

Vendor/consultant Email address*

Will the Employee need to access data remotely?*

NO

YES

Input Computer Name and/or PT # Designated to Employee*

Input Computer Name and/ or the Palomar PT#. *Note: If employee needs a loaner laptop, after the employee receives their Palomar email, please have the employee complete the Technical Equipment Removal Form found here: https://www.palomar.edu/is/forms/

List any additional phone extensions associated with account holder

List all phone extensions associated with account holder

List all email addresses/accounts associated with account holder

List any PeopleSoft Access associated with the user*

List any PeopleSoft Access associated with the user such as; PeopleSoft Finance, Human Resources and/or Student Services.

Will the account data be moved to the department share drive?*

Yes

No

Will the account data be deleted?*

Yes

No

Special instructions, please give details.

Please include any special instructions for employee account data. For example, provide the share drive location the data will be moved and/or individual(s) who will have access to the the data.