ACCESS COORDINATOR AUTHORIZATION FORM INSTRUCTIONS
Systems and Procedures
A Division of The Corporate Controller's Office
IN

ACCESS COORDINATOR AUTHORIZATION
FORM INSTRUCTIONS

Form Instructions

  1. Coordinator - Enter the name of the indiviudal being appointed Access Coordinator
  2. Area - Enter the name of the College, Campus, Department or Area being assigned to the Access Coordinator
  3. ID - Enter the Penn State Identification Number of the individual being assigned Access Coordinator
  4. Phone - Enter the Access Coordinator's campus phone number, including the area code
  5. Email - Enter the Access Coordinator's email address
  6. Office - Enter the Access Coordinator's office address
  7. USER - Enter the Access Coordinator's user identification number
  8. Check Box - Select all that apply. Check first box if ordering keys and/or check the second box if securing electronic access/C*Cure access
  9. Standing - Enter the standing order purchase order number if ordering keys
  10. Budget - Enter the budget number to be charged
  11. Check Box - Check this box, sign, and date the form indicating that consent of the following statement: "I have read, undertstand, and agree to comply in full with all of the terms and conditions of University Access Policy AD68 , Procedures SY2001 , and any other pertinent University policies in performing my duties as Access Coordinator. I understand that failure to abide by these terms may result in the termination of my duties as Access Coordinator, and could result in additional disciplinary actions."
  12. Signature - The Access Coordinator must sign the completed form in this area
  13. Access Coordinator - The Access Coordinator must enter the date upon which this form was signed
  14. Approval Routing 1 - The Departmental or Budget Executive must sign in this area
  15. Approval Routing 1 - The Departmental of Budget Executive must PRINT their User Identification within this area
  16. Approval Routing 1 - The Departmental or Budget Executive must enter the date upon which this form was signed
  17. Approval Routing 2 - The Facility Coordinator (University Park Only) must sign in this area
  18. Approval Routing 2 - The Faculity Coordinator must PRINT their User Identification number within this area
  19. Approval Routing 2 - The Facility Coordinator must enter the date upon which this form was signed
  20. Approval Routing 3 - The University Access Controller must sign in this area
  21. Approval Routing 3 - The University Access Controller must enter the date upon which this form was signed
  22. Termination of Access Coordinator Appointment - This section is completed only upon termination of an Access Coordinator appointment. A copy of the form is retrieved from the files and the ending date of duties is recorded within this area
  23. Departmental or Budget Executive - The Departmental or Budget Executive must sign within this area indicating their consent to terminate Access coordinator Authorization
  24. Date - The Departmental or Budget Executive must enter the date upon which this form was signed
Image of Access Coordinator Authorization form