UNMC Remote Access Request

Remote Access Request
Please note that VPN and Strong Authentication accounts are given as needed. Your request will be reviewed by an ITS Staff member and you may be contacted for further information. If the request is for a someone other than you, you may be required to have legal documents signed and returned to ITS prior to the installation of the VPN request. ITS will work with you to determine which Remote Access solution best fits the needs of the cardholder and ITS
Request For
Requestor Information (You)
First name:
Middle name:
Last name:
Phone:
Department/College:
Room Number:
Campus Zip:
Email address:
Organization:
Role:
Month of birth: (mm)
Day of birth: (dd)
Last 4 digits of SSN:
Additional Information
User's Operating System:
List IP address(es) and/or secured system(s) you need remote access to:
(You must have the appropriate ID/password for the secured systems noted.)
Remote Access Agreements
EXPORT INFORMATION: PLEASE READ CAREFULLY AND CHECK THE BOX BELOW!

If the computer for which the software is requested is located outside the US or Canada, or will be transported outside the US or Canada, or if you plan to export, transport, or download this software outside the US or Canada, please contact UNMC ITS Customer Support Services at 559-7700 prior to doing so. You will be advised if this is permitted under the licenses and/or license exceptions granted by the US Department of Commerce, Bureau of Export Administration. No resale, transfer, or export of cryptographic products outside the approved class of end users and countries is authorized w ithout prior w ritten authorization from the Bureau of Export Administration. If for other use, cardholder must sign this statement.

I have read and accept these conditions
Company/Cost Center Account Number:
STRONG AUTHENTICATION: PLEASE READ CAREFULLY AND CHECK THE BOX BELOW!

1. All information shall be safeguarded from use by unauthorized individuals.
2. All systems are property of UNMC and/or The Nebraska Medical Center and shall not be disclosed to any other organization.
3. Strong Authentication shall be for my use only and will not be given to any other individual for their use.
4. If Strong Authentication is lost, Information Technology Services shall be notified immediately at 559-7700.
5. If the user violates any of the above, UNMC/ITS may terminate the use of Strong Authentication.

I have read and accept these conditions
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