Evaluation Access Rights Waiver Form
Request evaluation access and acknowledge the waiver of certain rights and responsibilities.
Applicant Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Organization/Institution Name
*
Job Title/Role
*
Which system, software, or resource are you requesting evaluation access to?
*
Purpose of Evaluation (briefly describe why you require access)
*
Intended Evaluation Period
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Have you previously evaluated this or a similar system?
*
Yes
No
Supervisor or Manager Name (if applicable)
Supervisor or Manager Email (if applicable)
example@example.com
Please rate your familiarity with the system or resource you are requesting access to:
*
1
2
3
4
5
Signature
*
Submit Evaluation Waiver
Submit Evaluation Waiver
Should be Empty: