Enrollment Data Access Request Form - University at Buffalo

Employee InformationFirst Name:Department:Last Name:Campus Address:Enrollment DataAccess RequestUB Employment Title:Office Phone:UBIT Name:1. Add or Change AccessEmail Address:Person Number:I am a new user without HUB Access. Please create a HUB account and include the access checked below in #4.I am a current user of HUB and require a change to my account. Please change the access as checked below in #4.I am a current user of the HUB who has moved to a new department. My new department is:Please change my access as noted in #4.I have initiated the deletion of any access that I had in my old department that do not apply to my new position perUniversity policies.2. Remove AccessDelete all HUB Enrollment Access. The above named staff member is no longer employed by this department.Delete the HUB USERID. This employee is no longer employed at the University at Buffalo. I understand by initiatingthis, all HUB module access and InfoSource access will be deleted.3. Please indicate for which of the following careers you need access to enroll students into courses:Undergraduate Graduate Pharmacy Medical Dental Law4. Access Request for the Enrollment Module - Please check ONE from Section 1 (if applicable), ONE fromSection 2, and Section 3 (if applicable).Section 1 (Select one option from the three options below)ENROLLMENT UNIT REGISTRAR - Access to register students into classes both individually and in block. Only available forappropriate Law, Medicine, and Dental Medicine personnelENROLLMENT REGISTRATION SUPPORT - Access to register students into classes on an individual basis.Post Enrollment Requirement Checking (PERC) - Access to run the PERC process on classes within my departmentAcademic Org (Please provide your 4 digit code)Section 2 (Select one option from the two options below)VIEW ONLY - Access to view student registration and historical grade information.ENROLLMENT SUMMARY VIEW ONLY - Access to view student registration information.Section 3 (Select only if this applies to you)OVERRIDE ENROLLMENT LIMITS - Access to override the unit threshold (i.e. 19 hours for undergraduate) limit for student.Enrollment Request Form - Last Updated April 2013Page 1 of 2

Enrollment DataAccess Request (Continued)5. Please detail your role at the University, and specific reasons for requesting access to Enrollment data.Detail the type of student registrations you must perform.Departmental ApprovalAs a departmental approval, I certify that my employee has a VPN client installed on their machine. If a VPN client is not installed, pleasetake the initiative to contact your IT support to have a VPN client installed. Without a VPN client, the employee will not be able to accessHUB information.I support this request to add or delete access for the above named staff member.Department Head NameTitleEmailPhoneDepartment Head Signature:DateUser Agreement: I agree to utilize all UB data for business purposes only. I understand the confidential nature of the data andwill not disclose or use it for personal gain. I have read and will abide by the terms in the "University at Buffalo PoliciesRegarding Data, Security, Access and Acceptable Use of University Information."Employee SignatureDateReturn this form to: Office of the Registrar Data Custodian, 232 Capen Hall, North Campus; Phone: 645-5698 Fax: 645-7764Email questions to: HUB-SR-ACCESS-LIST@listserv.buffalo.eduProgram Plan Data Request Form - Last Updated April 2013 Page 2 of 2