Information Management Role Request
Submit a request to add, modify, or remove an information management role for yourself or another user.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Department
*
Please Select
Human Resources
Finance
IT
Operations
Sales
Other
Is this request for yourself or another user?
*
Myself
Another user
If for another user, please enter their full name
First Name
Last Name
If for another user, please enter their email address
example@example.com
Role Request Type
*
Add new role
Modify existing role
Remove role
Requested Role(s)
*
Data Entry
Data Analyst
Information Manager
System Administrator
Viewer
Other
System or Application Name
*
Business Justification for Role Request
*
Effective Date for Role Change
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Manager/Supervisor Name
*
First Name
Last Name
Manager/Supervisor Email
*
example@example.com
Additional Comments or Instructions
Submit Request
Should be Empty: