<p> 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</p><p>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.</p><p>Requesting department: </p><p>Requestor’s name: </p><p>Requestor’s address: Phone: </p><p>Requestor’s email address: </p><p>Request type: 1. Emergency Info Access 2. Access 3rd party email 3. Out of Office Message</p><p>User’s name: User’s location:</p><p>Purpose of request: </p><p>Specific files or equipment to be searched:</p><p>Date range for which data is needed (for example, 11/29 to 12/10/2007): ______to ______</p><p>Signature of requestor: </p><p>Name of Department Head/Chair: Date: </p><p>Signature of Department Head/Chair: </p><p>Request approved:</p><p>Chief Information Security Officer / VP for Computing & Information Services Date</p><p>Request approved:</p><p>Human Resources / Provost / Student Life / Public Safety Date</p><p>Request approved:</p><p>Office of General Counsel Date</p><p>Request for Privileged Access Current as of: 03/27/2009 cis.brown.edu/isg/forms</p>