ACBDD Security Request Form
Please provide the following contact information for the user:
Name Title Work Phone E-mail (not required for new user)
Choose the type of security request:
Request for New User Security Change Delete Security Other - explain below
Specify the date required. Please allow 5 days if possible. If this request is to delete security, please give the termination date:
Date:
E-Mail Access:
New E-Mail Access Change E-Mail Address (please specify in comments) Delete E-Mail Access
Select any of the following for access to data drives:
Read Only Access To Human Resources Drive M Update Access To Human Resources Drive M Read Only Access To Policy Drive N Update Access To Policy Drive N Read Only Access To Industries Accounting Drive Q Update Access To Industries Accounting Drive Q Read Only Access To Help Me Grow Drive S Update Access To Help Me Grow Drive S Read Only Access To MUI Drive U Update Access To MUI Drive U
Select those items listed below, if applicable:
Alchemy Access to Children's Files Alchemy Access to Adult Files Time Clock Plus Individual Role Time Clock Plus Supervisor Role If AFSCME, please note schedule in box at bottom of form Remove DODD Security Access Remove/Change OEDS Role in the ODE Web Portal Other (please specify in box at bottom of form) Other software to be loaded (specify in box at bottom of form)
Alchemy Access to Children's Files Alchemy Access to Adult Files Time Clock Plus Individual Role Time Clock Plus Supervisor Role If AFSCME, please note schedule in box at bottom of form Remove DODD Security Access Remove/Change OEDS Role in the ODE Web Portal Other (please specify in box at bottom of form)
Other software to be loaded (specify in box at bottom of form)
Select any of the following options for ACBDD Gatekeeper Access:
Case Notes Read Only PAAS Read Only Billing Read Only Workshop Read Only Demographics Read Only Case Notes Update Forms Module (IP & Plan) Case Notes Time Only Update Waiting List PAAS Update Billing Update Workshop Update Demographics Update Administrator Access
Select any of the following options for Help Me Grow Gatekeeper Access:
Service Coordinator Read Only Billing Read Only Demographics Read Only Service Coordinator Update Billing Update Demographics Update Administrator Access Printers and Bizhubs: Please enter the equipment the user needs to access in box below:
Service Coordinator Read Only Billing Read Only Demographics Read Only Service Coordinator Update Billing Update Demographics Update Administrator Access
Printers and Bizhubs: Please enter the equipment the user needs to access in box below:
Telephone:
New Extension New Voice Mail New Long Distance Access Change Extension (Please describe change in the box at the bottom of form) Change Voice Mail (Please describe change in the box at the bottom of form) Change Long Distance (Please describe change in the box at the bottom of form) Delete Extension Delete Voice Mail Delete Long Distance Access
Building Security, including keys:
Administration Building Access School Building Access Industries Building Access (Ada Road)
Clarify changes in the box below: