Request for Privileged Access

Computing & Information Services  ISG  Brown University B o x 1 8 8 5  3 D a v o l S q u a r e  P r o v i d e n c e , R I 0 2 9 0 3  4 0 1 . 8 6 3 . 7 2 6 6

Request for PRIVILEGED ACCESS Use this form to request access to information owned or administered by Brown University when such access is required for a current investigation. Completing a request is not a guarantee that privileged access will be granted.

Requesting department:

Requestor’s name:

Requestor’s address: Phone:

Requestor’s email address:

Request type: 1. Emergency Info Access 2. Access 3rd party email 3. Out of Office Message

User’s name: User’s location:

Purpose of request:

Specific files or equipment to be searched:

Date range for which data is needed (for example, 11/29 to 12/10/2007): ______to ______

Signature of requestor:

Name of Department Head/Chair: Date:

Signature of Department Head/Chair:

Request approved:

Chief Information Security Officer / VP for Computing & Information Services Date

Request approved:

Human Resources / Provost / Student Life / Public Safety Date

Request approved:

Office of General Counsel Date

Request for Privileged Access Current as of: 03/27/2009 cis.brown.edu/isg/forms