ACCESS COORDINATOR AUTHORIZATION

Form Instructions

1. Enter the name of the individual being appointed Access Coordinator
2. Enter the name of the College, Campus, Department or Area being assigned to the Access Coordinator
3. Enter the Access Coordinator's PSU ID number
4. Enter the Access Coordinator's office phone number, including the area code
5. Enter the Access Coordinator's office address
6. Enter the Access Coordinator's Penn State email address
7. The Access Coordinator must provide either a hand-written signature or provide their digital ID
8. If the Access Coordinator provided a hand-written signature, enter the date the form was signed. If a digital ID provided, skip this field
9. Check all privileges to be assigned to the Access Coordinator. Options include Key Ordering, Electronic Access/C*Cure, and Master Access Coordinator
10. The Master Access Coordinator must provide either a hand-written signature or provide their digital ID
11. If the Master Access Coordinator provided a hand-written signature, enter the date the form was signed. If a digital ID provided, skip this field