ACCESS REQUEST FORM

For NETWORK, E-MAIL, and INFINITE CAMPUS

Please complete this Access Request Form and have it signed by the Department Head/Director/Site Principal.

Scan and E-mail this completed Access Request Form to Support@scusd.edu

Requests will be completed within 48 hours. If you have questions, please call Technology Support at 916-643-9445.

** REQUIRED – PLEASE PRINT/TYPE - DOUBLE CHECK SPELLING!	Date:_Click here to enter a date.

** FIRST NAME and MIDDLE INITIAL: Click here to enter text. ** SCUSD PSL NUMBER: Click here to enter text.	** LAST NAME: Click here to enter text. Name Change? Previous Name: Click here to enter text.	** DOB: Click here to enter a date. ** GENDER: ☐ Male ☐ Female ** RACE: Choose an item.
Have you ever been a student or an employee of Sacramento City Unified School District?	☐ Yes	☐ No
** JOB TITLE: Click here to enter text.	DEPARTMENT/SCHOOL SITE/LOCATION: Click here to enter text. ☐ Elementary ☐ Middle School ☐ High School

Services Requested: (Please check at least one)

☐ New Employee Set up	☐ Permanent
☐ Employee Replacing: Click here to enter text.	☐ Temporary Dates: From: Click here to enter a date. To: Click here to enter a date.
☐ Change of Site Transfer From: Click here to enter text.	Transfer To: Click here to enter text.

Access Needed: (Please check all that apply)

☐ Exchange Outlook E-Mail	☐ Escape – Finance/Personnel/Payroll System ☐ ** Setup Escape Same As: (Mandatory) Click here to enter text.
☐ Infinite Campus	Job Description: Click here to enter text. ☐ ** Setup IC Same As: (Mandatory) Click here to enter text.

Notes: Click here to enter text.

AUTHORIZATION	** Print/Type Name of Supervisor:
** Contact Telephone Number:	** Supervisor Signature: