Web Services Request Form The University of Texas-Pan American

Department of Internet Services This form is used for requesting web space, for creation of a new site, or for access to an existing web site for a department, for a faculty page, or for a staff page. REQUEST FOR WEB SITE/ACCESS TO EXISTING WEB SITE

NATURE OF REQUEST REQUIRED Division: _____________________________________________

College: _____________________________________________

Department: _________________________________________

REQUEST TYPE: Departmental Faculty Staff

REQUEST TO:

Create Web Site Create Web Space only Access Web site Other ___________________________________

Select one or more which apply: Program: __________________________________________

Faculty Organization: _________________________________

Staff Organization: ___________________________________

Other: _____________________________________________

Other Description of Services, Tasks, Projects, Etc. USER INFORMATION Person Requesting site and access:

Full Name: _______________________________

UTPA Email: _______________________________

Phone: ________________________________

Affiliation with UTPA: Faculty Staff Student Employee (Work Study/Direct Wage) Other: ____________________________________________

ACCOUNT INFORMATION (for Departmental web site requests only) This section applies to Departmental web site request only. The Budgetary information is a confirmation that the request has been approved by your department. No fees will be accrued to your budget.

Budget Account Title Budget Account Number

______________________________ _____________________________ ______________________

Account Manager Name (Print) Account Manager Signature Date

USER ACKNOWLEDGEMENT Please read the following information carefully and sign below.

The University’s information is regulated under the “Texas Information Resources Management Act” and the “Texas Administrative Code”. Use of these resources is subject to the “Texas Computer Crimes Statutes” and the “Policy For the Use and Protection of Information Resources” of The University of Texas System and of U.T.-Pan American. Under these regulations you, as the owner of this account, are responsible and may be held liable for results arising from the use of the account. This includes, but is not limited to: output in printed form; E-mail and other forms of communication from the account; and the content of files residing in the account or transmitted from the account. A computer Internet access account holder may not be paid or otherwise economically benefit from the access and use of University information resources. I have read the above and acknowledge that state laws and regulations and The University of Texas “Policy for the Use and Protection of Information Resources” restrict the purposes for which Information Resources may be used. I understand that my failure to comply with the restrictions may result in the cancellation of my privilege of use, appropriate disciplinary action, and action by law enforcement authorities. I agree to take all reasonable measures necessary to protect the security of The University of Texas-Pan American’s computer systems, including my passwords regularly, not sharing my passwords with other individuals, keeping my password secret, and not leaving logged-in computers or terminals unattended and/or unsecured.

Computer User Signature ________________________________________________ Date __________________________________

FOR INTERNET SERVICES USE ONLY TRACKING DATES: PROJECT INFORMATION:

Date Received: __________________________________

Date Created: ______________ By: _________________

Date Emailed SYSTEMS: ___________________________

Date Review Completed: __________________________

Date Received Confirmation from SYSTEMS: ___________

Date Contacted User: ____________________________

Folder Name: __________________________________________

Assigned To: ___________________________________________

Completed by: _________________________________________

Manager Review: _______________________________________ _