Illinois Institute of Technology CNS
REQUEST FOR SIS ACCESS OR ACCESS-CHANGE
Complete this form and return it to:  Jeanne Garofalo or fax it to:
  Room 007B Stuart Building 312 567 3314
You will receive notice of your username and password and a packet of instructional material.
PLEASE PRINT (or type in form before printing)
Name Faculty  Staff  Student
Title Dept
Bldg/Room Phone
Same access as this user:
-- OR -- Check one:
Faculty or academic secretary Faculty with special update Inquiry on all screens
Inqry on non-academic scrns Financial Aid Level 1 Financial Aid Level 2
Financial Aid Level 3 Library Access Services Undergrad Adm Cnslrs
Undergrad Adm Tracking UndergrAdm & FinAid Lvl2 UndergrAdm & FinAid Lvl3
Undergrad Adm Data Maint Hermann Hall Staff Rice Campus Update
Housing, Full Update Housing Limited Update Downtown Campus Registrar
Graduate College Grad Adm Full Update Grad Adm Limited Update
Registrar Student Services Center Educational Services
Counsel & Health Svcs Public Safety  
I understand that by virtue of my employment at Illinois Institute of Technology, I may have access to records which contain individually identifiable student information, the disclosure of which is restricted by the Family Educational Rights and Privacy Act of 1974 (FERPA). I acknowledge that I fully understand that the disclosure by me of this information to any unauthorized recipient would violate FERPA and the Illinois Institute of Technology's policies on student records, and could constitute just cause for disciplinary action, including termination of my employment. I also will visit www.enrollment.iit.edu/ferpa/  for an online tutorial on the Family Educational Rights and Privacy Act (FERPA) before beginning to access student information through SIS (Student Information System).

Signature of person requesting access: __________________________________

Authorizing signature (usually department head): _______________________________
PRINT name of authorizing person:

**************************** CNS USE ONLY ************************* Upd: 02/11/2002
Alpha1 Username _____________________________________
Oper.#___________   Entered by:______________   Date:__________