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ةيدوعسلا ةيبرعلا ةكلمملا ميلعتلا ةرازو فوجلا ةعماج
ةينقتلا عيراشملاو تامولعملا ةينقتل ةماعلا ةرادلإا
Wireless Access Request Form
Request # _______________ Date _____________________
Details of requestor
Employee # Name
Department Job Title
Email address Mobile #
Device details
Smartphone Laptop / Tablet Other Device type
Description
Adequate Inadequate Unknown
Device security Details
University-owned Personal
Ownership MAC address
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14 ـه
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ةيدوعسلا ةيبرعلا ةكلمملا ميلعتلا ةرازو فوجلا ةعماج
ةينقتلا عيراشملاو تامولعملا ةينقتل ةماعلا ةرادلإا
Access requirements
Access requirements
Access to: Internal network Internet, via proxy Internet, bypassing proxy Location:
Duration: Temporary Indefinite
Justification:
Confirmation
Confirmation by requestor
Comments:
Name:
Date: Signature:
Confirmation by manager
Comments:
Name:
Date: Signature:
Confirmation by IT Support / Helpdesk
Comments:
Name:
Date: Signature:
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14 ـه
:تاقفرملا ...
ةيدوعسلا ةيبرعلا ةكلمملا ميلعتلا ةرازو فوجلا ةعماج
ةينقتلا عيراشملاو تامولعملا ةينقتل ةماعلا ةرادلإا
Approval
Approval by Head of Network Team
Comments: Approved Rejected
Implementation assigned to:
Name:
Date: Signature:
Approval by IT Security
Comments: Approved Rejected
Name:
Date: Signature:
Implementation
IT staff name:
Actions taken MAC whitelisted Registers updated Details provided
Comments:
Date: Signature:
