Systems and Procedures
A Division of The Corporate Controller's Office

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