Date:
Monday, November 28, 2022 ![Delete the Date Delete the Date](/WorkArea/images/ui/icons/calendarDelete.png) Employee Instructions:
Take the FERPA tutorial
Complete form online
Submit form electronically by clicking the Submit button.
Print and sign form and send to supervisor for signature
If you have questions, contact us at ITSAccess@govst.edu
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Employee Name (First and Last Name) |
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Title/Function |
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Unit/Department |
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GSU Email Address (For notification only) |
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Signature (Type first and last name) |
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IMPORTANT: Please Print and Submit
By submitting this form, the employee affirms that they have read and understood GSU policies and procedures regarding administrative systems access, and agrees to abide by GSU policies 61, 64, 65, and 71. These policies can be found at GSU Policies Page. GSU systems contain private and confidential information protected by federal (FERPA, HIPAA) and state (IIPA, IPIPA) laws that govern the access by, and disclosure of information to/by persons not specifically authorized by Governors State University. Typing my name in the signature box above constitutes my electronic signature.
PRINT the form, and send to your supervisor:
SUBMIT the form electronically so that ITS can receive notification:
Employee STOP: Only Supervisor below this section.
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Will employee schedule classes in Colleague?
Faculty MyGSU Portal access?
Will employee be adding/removing holds?
Will the employee require access to Perceptive Content?
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Name of user with similar rights or employee being replaced (N/A if not applicable) |
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Supervisor Name: (First and Last Name) |
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Supervisor signature (Required, forms not signed cannot be processed) |
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