Date of Request: _____________
Requestor Name: ______________________________________________________________
Former Employee’s Name: _______________________________________________________
Former Employee’s TUid: ________________________________________________________
Please list specific resources (for example, all files and emails related to admissions business):
_______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
DEPARTMENT APPROVAL:
Dean/Vice President Name: _________________________________
Dean/Vice President Signature: _________________________________ Date: __________
Once you have obtained department approval, please scan this form and email it to ciso@temple.edu for the university approval.
UNIVERSITY APPROVAL:
Chief Information Security Officer: _________________________________ Date: __________
VP for Information Technology Services: ____________________________________ Date: _________