Section 1: User requesting access or change completes Section 1 and signs the Confidentiality Acknowledgment

Section 2: Obtain signature of your supervisor or dean’s office

Route to the appropriate department for security authorization

Section 3: Authorizing department marks security level and signs

Route to Shelly Whittaker / DoIT – Old Gym

Section 4: Completed by DoIT

Originating user will be contacted for training if new functionality is requested

SECTION 1: Completed by person requesting access. Bolded fields are required!	Request Type: New Change Delete Banner ID:
Name:	NetID:	CU Phone:
Department:	CU Email:
Role: Faculty Staff Student Employee	Specific Data/Use Requested:
Supervisor:	Supervisor’s Phone:

CONFIDENTIALITY ACKNOWLEDGMENT

A. Creighton has compiled certain proprietary information about its students (hereinafter “Confidential Information”) in an information system known as “Banner” (the “System”);

B. Such Confidential Information is not public knowledge but it is proprietary and confidential;

C. Some of the Confidential Information is protected under a federal law known as the Family Educational Rights and Privacy act of 1974, as amended (“FERPA”), and persons may access such Confidential Information only in the legitimate educational interest of the student;

D. My job duties require that I have access to Confidential Information in the System; and

E. My signature on this document evidences that I understand the need to protect the confidentiality of the Confidential Information and the need for non-disclosure of Confidential Information.

I agree as follows:

1. Definition of Confidential Information. As used in this Agreement, the term “Confidential Information” means records which contain individually identifiable information about students (except information classified as directory information).

2. Training. I will become familiar with, and will periodically review, the requirements imposed by FERPA, by reviewing the information which is available to me at http://www.creighton.edu/Registrar/FERPA.ppt If I do not understand what is required of me under FERPA, I will ask my manager for further clarification.

3. Limited Information. I agree that I will only access Confidential Information which I need to complete my assigned job duties.

4. Use of the Confidential Information. I agree to use the Confidential Information only to perform my job duties. I will not make any personal copies of the Confidential Information. I will not disclose Confidential Information to third parties or use Confidential Information for my own purposes.

5. Ownership of the Confidential Information. All Confidential Information is and remains the property of Creighton.

6. No access by others. I will not share my ID or my PIN with any third person, other than my manager or supervisor.

7. Consequences of Failing to Follow FERPA Rules. I understand and agree that failure to follow the requirements of FERPA can be grounds for disciplinary action, up to and including termination of my employment.

8. No Contract of Employment. This Acknowledgment will not be construed as a contract of employment.

(RECIPIENT)

(Recipient’s Printed Name and Address)

Date: ___________________________________________

SECTION 2: Completed by Supervisor
Supervisor’s Signature:	Date:
My signature indicates that the security requested for the above listed person is appropriate for their job duties.

SECTION 3: Security Authorization – completed and signed by the appropriate department.
Recruit	Level U Q
Admissions	Level U Q
Other:
Signature of Admissions Department Director:
Registration	Level A U L Q
Catalog	Level A U Q
Class Schedule	Level A U Q
Academic History	Level A Q
General Student	Level A U L Q
Faculty	Level A Q
Building	Level A Q
Signature from the Office of the Registrar:
Financial Aid Applications/Common/Shared	Level A
Needs/Budget/Packaging/Fund Mgmt	Level A Q
Loan Processing	Level A Q
Requirements Tracking	Level A
Student Employment	Level A
Financial Aid Administration	Level A
Financial Aid Information Review	Level Q
Financial Aid Signature:
Student Accounts Receivable:	Level U Q
Students Accounts Receivable Signature:
Housing:	Level A U
Housing Signature:
Student Health:	Level A U Q
Student Health Signature:
Other Access Not Listed:	Level A U L Q
Authorizing Signature:
General Person Information Access to these forms will be granted upon completion of training.	Level U Q
Letter Generation Email Generation Job Submission
Power User Special Forms/Notes:

Section 4: Completed by DoIT
Username: ________________	Completed by: _______________	Date: ____________