F0020_A, Vendor VPN Request Form

Network Engineering and Technology
F0020_A
Vendor VPN Request Form

The Purpose of VPN

This form is to be used to request access for consultants to use the VPN connection supplied by Network Engineering and Technology. For staff use F0021, VPN Access for GMU Staff.

Instructions - PLEASE READ - Updated January 28, 2011

Fill out this form online then print the form prior to submitting. Submitting the completed form will generate a work ticket, however assignments will not be made without the signed forms. Fax signed forms to Network Engineering and Technology at 703-993-3505. All areas with bold italic print and asterisks (*) are required. Text in green are hyperlinks to policy pages or definitions for terms used on this form and why they are required.

If you have any questions, please contact the Support Center at 703-993-8870.

Departmental Information

Sponsor*			Title*
Department*
Mason Phone*			Mason Email*

Consultant Information

Company*			Phone*
Address*

VPN Access Requested for (at least first row must be completed*):

Name	Email	Phone	Office Location

*Acccess Dates

Start Date:

End Date:

*Reason for VPN Access

*Resources to be accessed. In order to have your request completely in a timely fashion, please include a domain name (blah.gmu.edu) or an IP address and the TCP/UDP ports you will need opened.

Sponsor:

Signature: ____________________________________ Date: ___/___/____

This form will print when submitted. Please fax signed forms to 703-993-3505. it so that a work order can be created.

If necessary, use this button to .

For Administrative purposes only

Status: Approved Not Approved
Date: ______/_____/________
Signature:______________________________

Website Contact:
Net Webmaster
Network Engineering & Technology
George Mason University
Aquia Building, Mailstop 1B5
4400 University Dr.
Fairfax VA, 2030-4444

Phone: (703) 993-9045
Fax: (703) 993-3505