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Please deliver completed form to: ITIS Database Administration Young Hall (YONG) Database Account/Privileges Request Form Infrastructure Services Database Administration Account Type (check all that apply): Individual Shared Oracle SQL Server (check one of the following for SQL Server) SQL Server Authentication Windows Authentication Windows Group New Existing Account Information: Career Account Login: Purpose: IP Address: First Name: Middle Initial: Last Name: E-Mail: Campus Phone: Project Team: Department: Signature: Requester Information: (if different than account information above) First Name: Last Name: E-Mail: Campus Phone: System Owner Authorization: Name: Signature: Data Steward Authorization: Name: Signature: Complete access privileges on next page Database Account/Privileges Request Form, Continued Requested Privilege Domain: (check all that apply) Production Training QA Development Other (Specify) ________________ Requested Access / Change to Load Directory: No. (We don’t use LOAD directory) Yes. Deny Existing Access Requested Access / Change: Delete Account Remove Indicated Access Add/change access Privilege Level Database Name Object(s) Owner Read Write Please do not write in this section For use by ITIS Database Administration Completed by: Date: Read Only Execut e