Employee IT Resource Request Form

Requestor Name*

First Name

Last Name

Requestor Title*

Requestor Phone*

Requestor Email*

Employee First Name*

First Name

Last Name

Employee Job Title*

Employee Status*

Employee CWID*

*If you do not have the employee's CWID, Please contact HR for this information.

Employee's Email*

*Please enter employee's @mercy.edu e-mail address

Action being requested:*

Design account creation date*

Design account deletion date

Department*

Location*

Manager's Name*

IT Access

Banner Access

Xtender

Argos

Cashnet Access

Yes No

FormStack Access

Yes No

Please add the names of the FormStack folders

Slate CRM Access

Yes No

Network Drive Access

read only access read & write access full access

Network Drive Path

Issue Standard Desktop Bundle

Existing New Dept Funded

To see details on the standard desktop/laptop configurations. Click here If a non-standard system is desired please provide details in the Comments/General instructions text box.

Issue Standard Laptop Only

Existing New Dept Funded

Issue Standard Laptop Bundle

Existing New Dept Funded

Issue Smartphone

Existing New Dept Funded

Issue Basic Cell Phone

Existing New Dept Funded

Issue Desk Phone

Existing New Dept Funded

Comments/General Instructions