Web Access Restriction Request Form
Submit a request to restrict or remove access to a website or online resource. Please provide complete and accurate information to ensure prompt processing.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Department or Unit
*
Please Select
IT
HR
Finance
Sales
Marketing
Operations
Other
Name(s) of User(s) to Restrict
*
User Role/Position (if applicable)
Website or Resource URL to Restrict Access To
*
Type of Restriction Requested
*
Block all access
Restrict access during specific hours
Limit to read-only access
Other (please specify)
Reason for Restriction
*
Is this restriction temporary or permanent?
*
Temporary
Permanent
If temporary, please specify the start and end date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Urgency Level
*
Please Select
Low
Medium
High
Manager or Supervisor Approval (if required, upload signed document or email)
Upload a File
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Choose a file
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Additional Comments or Notes
Submit Request
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