TPX Authorization Form

Please PRINT the following information. Fax completed form to Client Support Services at 500-4850. You will be notified when processing is completed. For TPX training, contact Client Support Services at 500-4848.

SSN:  TPX Userid:
Name: 
(First, MI, Last)
Office Phone  ( )-
UT Dept:  UT Bldg Code/Rm
If you are not employed directly by UT-Houston Health Science Center, please provide the name of your employer (e.g. Hermann Hospital, MD Anderson): 

List all applications you will be accessing through TPX: 

***SECURITY CONTRACT*** 

All individuals are responsible for the management of information 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 userid/password for the purpose intended and not to share or disclosure a password. Failure on the part of any individual to comply may result in disciplinary action including suspension without pay or termination of employment 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.

__________________________________________
Employee's Signature 

Date 

***SECURITY AWARENESS INFORMATION***

The Department of Information Resources (DIR) mandates that all university employees or contracted personnel considered to be in a position of special trust must have access to security awareness information. All employees or contracted personnel with TPX userids are considered to be in a position of special trust and are required to obtain this information.

A security awareness brochure is available at new Employee Orientation or through Client Support Services. Information on security awareness can also be found on the Web at: "is.hsc.uth.tmc.edu/css/risk/riskmanu.html"

A security awareness video is available from Client Support Services and is available upon request. If you have any questions about security awareness, contact Client Support Services at 500-4848.

Printing & Faxing Instructions 
 

Return to the Electronic Forms Home Page  Return to the Information Services Home Page 

agb
Last updated 6/17/1998