Requester Information (supervisor or person filling out this form) Requester Information (supervisor or person filling out this form) Department Requester Requester Telephone Requester Email Employee Information Employee Information First Name Last Name NetID University ID Employee Type - Select -Full-time FacultyPart-time FacultyAdministratorStaffGAStudent Worker Employee Extension Employee Title Employee Last Day Office, or Workstation Location Functional Area (e.g., Faculty, Student Services) Has a Gallatin laptop and/or peripherals Yes No Keys Keys Keys Master (all doors) Semi-master (floor entrances) Specific room / floor keys (please specify) Other: Specified room / floor key Building Access Building Access Building Access Weekdays 8:00 a.m. to 9:00 p.m. 8th Floor File Room Weekends, After Hours, & Holidays (please specify reason) After Hours Access Please select "yes" for any systems the departing employee has current access to. Gallatin Network Computer Yes No SIS/Albert Yes No Registrar Electronic Memo Yes No Student Records Reporting Dashboard Yes No Email Direct Submit/Approve Access Yes No CMS Access Yes No Access to Hermes Yes No Email Aliases or Google Groups Shared Drive Access, G: Gallatin Yes No Shared Drive Access H: Yes No Shared Drive Access, Other Yes No Special Folders/Access WebNow/ImageNow Student Records Access Yes No ImageNow Scanning Access for HR Yes No NYU Box Account? Yes No Email Address to Copier for Scanning Yes No EMS Scheduler/Approver (Desktop Client) Yes No EMS Requester (Web Only) Yes No Submit For people in the EU, see information on your privacy rights under GDPR.