Section I

New Account Request
Delete Account

Name:
Department Name: HRMS Dept. #:
TPX User ID: IMAGINE User ID:
Employee ID # : Bldg Code/Rm:
Phone: Fax:
 
All individuals are responsible for the management of information resources and are accountable for their actions relating to information resources security. Individuals using information resources are expected to know and comply with published university policies and procedures. By signing this contract, you agree to only use the user ID/password for the purpose intended and not to share or disclose a password. Failure on the part of any individual to comply may result in disciplinary action including suspension without pay or termination of employment or contract. A person may be subjected to civil or criminal legal sanctions when a violation occurs. It is the responsibility of all personnel to report any suspected or confirmed violations of this policy to Client Support Services or the appropriate management.



_____________________________________________         Signature of Security Administrator:                    




___________________
Training Verification

___________
Date:
Individuals using information assets and computer resources owned by the UTHSCH will be held accountable for such use and are expected to familiarize themselves - and comply with - published UTHSCH and departmental security procedures and guidelines. Failure to comply with these policies, or procedures and guidelines may result in disciplinary action up to and including termination of employment or contract and my constitute a basis of legal proceedings. For more information, please visit HOOP Chapter 17: Responsibility for the Use of Information Resources.

I understand the provisions described in the Guidelines above, and accept personal responsibility for complying to them:


___________________________________________________
Signature of Employee:

___________
Date:


___________________________________________________
Signature of Supervisor:

 ___________
Date:

Please PRINT and fax completed form to 713. 500.4850. You will be notified when processing is completed.