Instructions: Fill out the form from your computer then print for signature then Scan completed
form and email to Ivan.Vasquetelles@Downstate.edu. If form is not filled out electronically it
will not be accepted.
Downstate PC
Manager’s Name:
Network SUNYUHB
Login ID:
Social Security:
Manager’s Signature:
(Required)
Title:
Manager’s Phone:
Department:
Manager’s Email:
Temporary
Employee Email:
Please Select Your Company:
11 Hospital
12 University
OTHER ________________________
System Requirements:
Yes
No
Does the user have access to own PC?
Does PC meet minimum requirements? (Pentium III, 256 MB ram)
Yes
No
Computer Name? See Example below
“INSVR030310DX04.uhb.downstate.org”
Does user have Internet Explorer 6.02, 7.0 or 8.0? If not please list version
Yes
No Version______
Does User need Lawson Training?
Yes
No
BUSINESS APPLICATIONS GROUP
Page 2 of 4
1/28/2015
Last date form updated 1/28/2015
Form ID 132