NetworkProject Request Form

I.Project Request:

Request Title: / Date Submitted:
Requester’s Name: / Requester’s Email: / Requester’s Work Extension:
Requesting Department: / Contact Going Forward: / Contact’s Work Extension:
Preferred Completion Date: / Sponsor’s Name: / Sponsor’s Work Extension:

Vendor & Funding:

Vendor Name:

/

Add vendor name, address, web page link

Vendor Contact:

/

Vendor contact name, title, phone number and email address

Estimated Cost:

Approved Budget Amount:

Who from FAMU is Funding this Request?

/

Name, department

Request Description and Business Case: (Describe the business problem you need to solve and how the solution will help)
How will the request help achieve the Strategic Plan? (How does it align with the University Strategic Plan?)
Goals and Objectives:(How will this request benefit the FAMU University and the Stakeholders?)
Success Criteria: (What are the measurements to be used to determine success?)
Comments:

II.Department Contacts

Contact The Following Departments Confirming If They Would If They Would Benefit From This Request/Technology:
Department / Contact / Contact Email Information / Response/Feedback*
Grad and UGRAD
Admissions
Advancement
Budget
Pharmacy
Facilities
Financial Aid
Human Resources
Information Technology Services
Law School
Plant Operation Maintenance
Registrar
Student Affairs
FAMU Police Department
* If a department is interested, please add their representative to “Resource Projections,” below.
Resource Projections: (Identify what internal departments should be involved)
Department / Department/Area Information
Example: Office Student Affairs / Example: Study Abroad
.

Please include any documentation that will support the request

III.Security Assessment:

Confidential Information: (Will your Request contain confidential information – SSN, Financial Accounts, Credit Cards, RAM Cards, FERPA data, or required by contract or law. For more information about FAMU Confidential information please refer to the Written Information Security Policy )
Will this Request contain or process any Confidential Information:
Yes No Unsure / If yes, select ALL types of data that apply:
Social Security Number
Financial Account Numbers /
Credit Card Processing
FERPA / HIPAA
By Contract or Law
Other
Will this service be publicly available? Yes No Unsure
Data Storage Location: (Where will you store and or output data and the formats for this data)
Data will be stored and outputted in the following formats: (Check all that apply)
Will be stored in Paper Format
Will be stored in Electronic Format / Will be output in Paper Format
Will be output in Electronic Format
None of the above
Planned Location of Data (if known please list)
Third Party: (note any third parties involved in supplying, processing or maintaining any data or software required by this Request)
Plan to use a Third Party as part of this Request to process store or send data to/from.
Yes No Unsure
Vendor Name / Current Vendor Contact if available
Users Who Have Rights Or Access: (Check the appropriate boxes. Enter the username(s) who will review or maintain approve access)
Will this Request require multiple users to have access to administer the data
Yes No Unsure
Department Administrator(s) who will approve user accounts and access levels
Name / Current Title
What is the system for security Roles? Colleague Workday New System Other
Are the security models of the systems being integrated automatable? Yes No
Authentication Method Supported: iRattler VPN CAS Other None of our methods
Who owns security role definitions and maintenance? Business Unit ITS Other
Regulations: (Is the Request required to conform to any regulations (i.e. MA 201 CMR, Red Flags, PCI, HIPAA, Sarbanes–Oxley, etc.).
Will this Request be required to conform to any Federal/State regulations?
Yes No Unsure
201 CMR 17
Red Flag Rules
FERPA / HIPAA
PCI / GBLA
Sarbanes–Oxley
Other

IV.Signatures:

The request is not complete without the following signatures. When complete, please either email a scanned copy to

or send a hard-copy via interoffice mail to the ITS Networking Services. Also, please keep a copy for your records.

Requester’s Signature: ______Date: ______

Manager’s Signature:______Date:______
(for Submission Acknowledgement)

VP/Sponsor’s Signature:______Date: ______
(for Submission Acknowledgement)

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