Remote Access SSL-VPN Request

(Please print clearly or type):

SECTION 1

(Filled in by user/applicant)

Last Name__________________________________

First Name_______________________________

CCBC Username________________________________ Ext. Number____________________________

Campus__________________ Department___________________________ Room Number__________
Full Time
Part Time
Student
Email Address_________________________________________________________________________
SECTION 2

(Filled in by user/applicant)

Description of Requested Access or Change to Security Role Assignment

Banner
ConEd Supplementary
Mapped Network Drives
SharePoint
Other _______________________________________

SECTION 3

(Filled in by Supervisor)

Supervisors Name ____________________________________________________________________

Email Address________________________________________________________________________
Remote Access Security Role Assignment
______________________________________________________
Supervisors Signature_______________________________________ Date_______________________
SECTION 4 (Filled in by Dean/Director/Vice President)
Name___________________________________________________________________
Signature________________________________________Date____________________
SECTION 5 (Systems Engineering)
User's Login Username to VPN____________________Date Completed_________________
DBA notified for ConEd Supplementary access:
E-mail
Applicants Supervisor Notified of Granted Security Via:
Voice-Mail
E-mail to Supervisor Other_________________
261589991 6/3/2010

THE COMMUNITY COLLEGE OF BALTIMORE COUNTY

NON-DISCLOSURE AGREEMENT
By signing this application, I agree to treat as confidential all CCBC owned, leased, or
licensed programs, files and information contained therein or generated by any
program using proprietary files or information to which I have been granted access.
I agree that except as authorized by The Community College of Baltimore County
(CCBC), The CCBC Board of Trustees, or bona fide agents including President, Vice
Presidents, Deans, Directors, and Managers empowered to authorize activities for the
performance of the tasks assigned, duties, responsibilities and expectations specified in
my Position Description, I will not copy nor disclose to any party, (including CCBC
employees, CCBC students or anyone else) proprietary or confidential information,
including proprietary licensed software residing on the CCBC computer systems. I
also agree not to disclose to any party (including CCBC employees, CCBC students, or
anyone else) my access codes and passwords.
I further agree to keep confidential any and all data or information, concerning
CCBC's students, employees, vendors, and donors, as well as CCBC's proprietary
information, whether in electronic or printed format, in accordance with the policies
and procedures of the Community College of Baltimore County (CCBC) as defined
under the Acceptable Use of Information Technology in the CCBC Employee
Handbook, and any applicable District State, or Federal Laws. The confidentiality of
student records is defined in the provisions of the Family Educational Rights and
Privacy Act, as amended (20 U.S.C. 1232(O)), and with the regulations issued
thereunder by the U.S. Department of Education.
I understand that if I fail to abide by these conditions, my access to any and all CCBC
computer systems may be terminated and that disciplinary action may be initiated as
stated in the CCBC policy manuals.

_____________________________________________________
Applicants Signature

________________________
Date

261589991 6/3/2010