contractor/vendor account request

This form must be completed by the Account Sponsor and submitted to the IT Security Office. The form can be faxed to (405) 325-1633 or emailed to security@ou.edu. Handwritten forms are not accepted.

  ACCOUNT SPONSOR
     
Sponsor 1: Email:
OU Net ID (4+4):      Incoming Conference Call Scheduled?
Phone:      Closure Meeting Scheduled?
  CONTRACTOR
First Name:   Middle Name:
Last Name:   Date of Birth (mm/dd/yy):
Company Name :   Company Address:
Company Email:      
OU ID #:   Phone:
Date Requested:   Expiration Date:
  IT SECURITY APPROVAL
 Approved By:  
  REASON FOR REQUEST

 ACCESS NEEDED (SYSTEMS)
System 1:   System 2:
System Name:   System Name:
System IP:   System IP:
System Application:   System Application:
Application Port:   Application Port
Expiration Date   Expiration Date
Additional Instructions:   Additional Instructions:
System 3:   System 4:
System Name:   System Name:
System IP:   System IP:
System Application:   System Application:
Application Port:   Application Port:
Expiration Date   Expiration Date
Additional Instructions:

 

   Additional Instructions:
If access is needed for additional systems, please complete a second form with additional access information only.
 ACCESS NEEDED (NETWORK)
VPN: Campus (default) Management SSL SSH Bastion Host
 
Firewall ACL Change:
         
Content Switch Change:
________________________________________   ______________________
Sponsor Signature   Date

________________________________________   ______________________
Security Signature   Date