Authorization Override Request Form
Submit a request for an override of standard authorization protocols. Please provide all required details for review and approval.
Full Name
*
First Name
Last Name
Department
*
Job Title
*
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
System or Process Requiring Override
*
Type of Authorization Override
*
Please Select
Access Level Increase
Temporary Permission
Policy Exception
Other
Justification for Override Request
*
Requested Duration for Override
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Supervisor/Manager Name
*
Potential Impact if Override Is Not Granted
Upload Supporting Documentation (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Signature
*
Submit Request
Submit Request
Should be Empty: