Network/Email Account Request for Affiliates

Information Technology Services Form ITS-8808-ES Rev -- 9/8/17 Page 2 of 2

This request is exclusively for University affiliates to request a Cal State LA network and/or email account. Accounts for students and University employees are automatically created through the appropriate administrative system.

Campus Sponsoring Requester must complete section 1, affiliate applicant must complete section 2, and sign section 3.

1.  Affiliate User Information

Last Name / First Name / Employee ID #
Other names used, if any / Extension / Office Location
Email
College/Division/Organization / Department/Unit
Position / ASI
UAS Staff / U-SU Staff
UAS Student / U-SU Student
Volunteer / Visiting Scholar
Other Describe:
Have you ever had a Cal State LA account before? / Yes No If Yes, what was your userID?
Special Instructions (optional)

2.  FERPA Certification

All applicants for a Cal State LA network or email account are required to view the online FERPA tutorial, answer the questions, and print and attach a current Certificate of Completion to this form. Applicants will receive an email notification if the Certificate of Completion is missing or outdated.

FERPA Certificate of Completion (Required for all positions)
Applicant has completed online FERPA tutorial within the past two years and a current Certificate of Completion is attached.
If NO, click on “Finish Later” under “Other Actions” to save this form. Complete the tutorial and obtain a new certificate by going to http://www.calstatela.edu/its/itsecurity/ferpa/index.php.
Clicking YES to proceed without a current certificate will result in processing delays. / Yes

3.  Acknowledgement of Confidentiality and Appropriate Use of Account

Under the Family Educational Rights and Privacy Act (FERPA); applicable federal and state laws and regulations; CSU Information Security Policy and Executive Orders; and Cal State L.A. Administrative Procedures and Policies, standards and guidelines, those Cal State LA affiliates with access to any and all institutional networks, systems and data are entrusted to maintain the security and confidentiality of institutional information assets. Authorized affiliates (referred to as system users in this document) are expected to adhere to the following rules:

1) Unauthorized use or access to institutional system records and information is prohibited.

2) Disclosure of any account information and passwords to anyone is prohibited.

3) Accounts granted to system users may be used only for work associated with the programs of California State University, Los Angeles or the California State University system.

4) Exhibiting or divulging the contents of any record or report to any person except in the execution of normal duties and responsibilities is prohibited.

5) No official record or report or copy thereof, whether paper or electronic, may be removed from the office where it is maintained except in the performance of system user’s job duties and responsibilities.

6) Using any institutional data or information for gender or ethnicity-based recruiting/selections, unauthorized fund raising, or other barred activities is prohibited.

7) Personally benefiting or allowing others to benefit from any confidential information, or knowledge thereof, gained by virtue of work assignments or network or system access is prohibited.

8) Directly or indirectly causing the inclusion of any false, inaccurate or misleading entries into any records or reports is prohibited.

9) All systems must be locked (Ctrl/Alt/Del) or completely exited before leaving a computer or server unattended.

10) Adequate security standards and precautions for access, use, retention and disposal of Levels 1 and 2 confidential data as outlined, described or defined by applicable federal and state laws and regulations; CSU Information Security Policy and Executive Orders; and Cal State LA Administrative Procedures and Policies, standards and guidelines must be maintained.

11) Violation of security precautions to protect confidential information may be a crime, and may be subject to appropriate legal action.

12) No one is to aid or act in conspiracy with another to violate any of the rules listed above.

I have read and understand all the rules listed above, and I agree to abide by them. I will maintain the security and confidentiality of any institutional information assets entrusted to me as stated in the rules above. If there is reason to believe there is a violation of University information security, FERPA, or federal or state laws, statutes and regulations, I understand that my access, account(s), account contents may become subject to monitoring and examination by authorized personnel.

Applicant’s Signature

Name / Date

4.  Access Approvals

Only requests with original or valid electronic signatures will be processed. All others (i.e., faxed, photocopy) will NOT be accepted.

A scanned image of a handwritten signature is considered an equivalent to a written signature for the purpose of indicating review, role assignment and/or approval for this form. I understand that an electronic transaction record, including, but not limited to, the e-signature, IP address, email address and time stamps, is created and retained for audit compliance purposes. I am the designated individual responsible for signing the applicant’s form.

Department/Division

By signing this request, approvers affirm that the applicant requires access to the University network and/or email account to conduct assigned responsibilities or perform associated work for the University.

Responsible Administrator (including University Auxiliary Services, Inc.) / Date
Security Review Completed
Comments and Corrections
Director, IT Security and Compliance / Date