Employee VPN Request

Please complete this form, and click the submit button at the bottom.

General Information
Date Date / DD / MM YYYY

Enter application date
Employee Name Employee Name First Last
Employee name for whom VPN is requested
Employee Banner ID
Must be 9 characters. Currently Entered: 0 characters.
Banner ID of employee for whom VPN is requested
Employee Email Address

E-mail address.
Manager/PBO Name

Manager name and e-mail address required for approval.
Manager Email Address

Manager name and e-mail address required for approval.
Department Name

Select department name. If not present select Other and fill in below.
Other Department
Business Need/Application Required

Business Need/Application Required Banner FAST Shared Folders Other Other
Confirmation

Confirmation I confirm that this request is for VPN for my Ontario Tech assigned laptop/tablet.

VPN to be used on institutionally owned device only
Asset Tag

Asset tag of institutional laptop
By submitting this document the Employee agrees to the following with regard to the VPN client install:

1. The Global Protect VPN Software is only approved for installation on assets owned by Ontario Tech compliant with the Technology Use Policy (May 2012).
2. The Global Protect client is approved for installation on ONE device per staff member.
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.