Please allow 3 to 5 days from submission for account creation

Complete the form below and click Submit Form. Upon submission, the form will be reviewed and verified. Then the user's account will be created.

* Indicates a required field Note: This form cannot be processed until the employee's classification has been updated in the Colleague system by the Human Resources Department.

Employee Information
First Name:

Middle Initial:

Last Name*:

Phone Number*:

Global Address Display:

(ex. John Smith, J.D. Smith, John "Scooter" Smith, etc.)

School or Division*:

Wesleyan ID Number*:

Employee's Job Title*:

Building*:

Employment Affiliation*:

**Please note: A termination date is required for all employees classified as "adjunct faculty", "student employee", "part-time faculty", or "temporary employee"
Termination Date*:
mm/dd/yy
Dean/Supervisor's Name*:

Supervisor Approved:


Requested Access

In the field below, list all shared email accounts, shared departmental drives, shared folders, group memberships,
and network printers to which the identified employee needs access.

If email, file, and print services are not required, please type "none".


Will this employee need access to the Datatel system (CF, ST, CA, etc.)?


Please Note: If you indicated "Yes", please click on the specific hyperlink below that corresponds to the needed WIN (Datatel) access:

Colleague Advancement Access
Colleague Financials Access
Human Resources Access
Student System Access

The form must be signed by both the employee's supervisor and the team leader of the requested access and delivered to EJW B-32.
Additional Information:


Has the identified employee read the University Policy for the Acceptable Use of
Information Technology Resources and the Policy for Acceptable Use of Network Resources statements?


Please note: If you indicated "No", the form cannot be processed.
The employee is required to review the applicable policies prior to being issued an account.
The applicable policies can be found on the Policies and Procedures page of the IT web site.

Has it been communicated to the identified employee that failure to adhere
to these policies may result in the revocation of all network/computer system rights?
Yes
No


Computer Information Assigned University computer?:
Yes
No
Yes? Asset Tag Number: