ACADEMIC UNIX / LINUX ACCOUNT ACCESS FORM
The following form must be completed and signed by faculty / staff members to maintain academics related web content.
*
*
Date: ________________
D.O.B
: ________________
Last 4 of SS# or Empl ID
: __________
*
*
First Name
: __________________________
Last Name
: ___________________________
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*
Department Name
: ____________________
Dept. Mgr. Name
: ______________________
Room Number: ________________________
Phone Number: _________________________
Full-time Staff
Part-time Staff
Student-worker
Full-time Faculty
Adjunct Faculty
COMPUTER ACCOUNTS
The following account will be issued: Academic Unix/Linux:
APPLICANT SIGNATURE
I have read the attached policy statements (PS 08.A.04 and PS 08.A.05 and UHD Password Procedures) and I
agree to abide by them. I further agree that I will not disclose personal or confidential information obtained through
the use of University of Houston-Downtown computer account(s).
By signing this form, I understand that by virtue of employment with the University of Houston-Downtown, I may
have access to records that contain individually identifiable information, the disclosure of which is prohibited by the
Family Educational Rights and Privacy Act of 1974, as Amended (FERPA).
I acknowledge that I fully understand that the intentional disclosure by me of this information to any unauthorized
person could subject me to criminal and civil penalties imposed by law. I further acknowledge that such willful or
unauthorized disclosure also violates policy of the University and could constitute just cause for disciplinary action
including termination of my employment regardless of whether criminal or civil penalties are imposed.
Applicant’s Signature: _______________________________ Date: __________________________
This form must be completed and submitted to Information Technology office at South – 700.
For IT Use: Date Received: _______________ Call #: ____________________
University of Houston-Downtown
Division of Information Technology
* - Required Field
Last Revised on: 6/12/2007