PeopleSoft Security  Form

This form must be signed by the userís manager.  If requesting access to a PeopleSoft module that is outside of  the requesting manager's area of authority, then an additional signature from that appropriate area requires an additional signature granting permissionPlease forward this completed form to the Information Technology Office. Empl ID is Employee ID or Student ID number.

Please Type or Print Clearly

 New Users Name:
 Phone:  Empl ID#
 Division/Dept. :  Position/Title:
 Type of Request:  (check one)  New User: Existing User:
 *Windows Account

* Must have a Windows Login account before requesting PeopleSoft User ID.

Check Database:

 HR/SA > Live Production
 HR/SA Test
 HR/SA Pre-Production
 Specify Other  Specify Other

PeopleSoft Module Access Authorization

User ID or User Name: New User Name:

Manager's Name: Date:

Manager's Signature:______________________________________________

Authorizing Manager's Name:

Authorizing Manager's Signature:___________________________

To be completed by Information Technology:

User Name: __________________   Account: _______   Created By: _______________ Date: ________
Form Revision Date: 05/01/2017