Form 99 S002 – Fill Out and Use This PDF

Grant Delivery System (GDS) - WebGrants

System Administrator's Access Request Form

A signed GDS - WebGrants Information Security and Confidentiality Agreement must be received and approved by the California Student Aid Commission prior to gaining access to the GDS - WebGrants. All fields are required to obtain a

System Administrator's (SA) User Id and Password. System Administrators & Authorized Officials must renew each year.

I. Institution Section

Primary Institution Name and Address

Primary Institution USED ID Code

			____ ____ ____ ____ ____ ____	- ____ ____
Additional Institution Names (If the Authorized Official and			Additional Institutions USED ID Codes
System Administrator are different at each institution, a separate
Agreement must be completed.)			____ ____ ____ ____ ____ ____	- ____ ____
			____ ____ ____ ____ ____ ____	- ____ ____
			____ ____ ____ ____ ____ ____	- ____ ____

II.Personal Information Section (to be completed by person requesting access)

Special Identifier (Check only one; limited to nine alpha-numeric characters)

Model of your first car (ie, Mustang)	Pet's name
Favorite food	Other

I certify that I have received and reviewed all security and confidentiality policies and annual training pertaining to the use of the Commission's GDS - WebGrants systems and data.

III.Access Request and Institution Certification Section(to be completed by Authorized Official - AO) (Note: The Institution's AO and SA may not be the same individual.)

I certify that I have designated the above named employee as GDS - WebGrants System Administrator and that I have reviewed all security and confidentiality policies pertaining to its use.

___________________________________________	(____ ____ ____) ____ ____ ____ - ____ ____ ____ ____
Name of AO - print or type	Telephone Number
____________________________________________	(____ ____ ____) ____ ____ ____ - ____ ____ ____ ____
Title	Fax Number
____________________________________________	_______________________________________________
Signature	Email Address

Form # 99-S002 02/26/2008

How to fill out the System Administrator's Access Request Form

This form is required for the institution's System Administrator.

It is to be certified by the Authorized Official and returned to the Commission.

I. Institution Section: (All primary institution fields required)

•Fill in the institution's name, address, city, state, and USED ID code (including two-digit campus code). List all active USED ID codes that will be used at your institution. (If the Authorized Official and System Administrator are different at each institution, a separate System Administrator's Request form must be completed.)

II.Personal Information Section: (All fields required)

•Enter Last, First and Middle Initial of the System Administrator requesting access.

•Requesting System Administrator must enter a unique 9 maximum alpha-numeric character Special Identifier, which will be used by the Help Desk to verify the identification of the person needing access. Special Identifiers may be the model of your first car, your favorite food, your pet's name or other lesser known info. When calling the Help Desk for assistance, you must provide your Special Identifier to verify your identity. Passwords and IDs will NOT be released without this confirmation.

NOTE: All System Administrator's email addresses will be added to the WebGrants list service for periodic updates relative to WebGrants system availability, Production Schedule changes and training opportunities.

•The System Administrator must sign the form and certify that all security and confidentiality policies have been received and reviewed.

III.Access Request and Institution Certification Section:

•Provide the date the form was completed and the requested effective date for the addition or change. Accounts will expire 1 year from the date of entry by CSAC Help Desk employees.

•Check the appropriate box:

New access - Once approved and processed, the new ID will be mailed directly to the System Administrator. Secure passwords will be emailed to the System Administrator.

Renew or Change existing access. Delete access.

For request types of Change, Renew and Delete, please provide the User ID that was issued by the Commission in the space provided.

•Enter the name, title, telephone number, facsimile number and e-mail address of the institution's Authorized Official verifying this request.

•The institution's Authorized Official MUST sign the form.

NOTE: The institution's Authorized Official and the person requesting System Administrator access may not be the same individual.

Mail originals to:

California Student Aid Commission

School Support Services Branch

Attn: IPA Processing

P.O. Box 419027

Rancho Cordova, CA 95741-9027

Retain a copy of this completed form.

	FOR COMMISSION USE ONLY.
Date Received:	___________________________________	Date Updated: ___________________________________
Help Desk Review: ___________________________________		Date:	___________________________________
ISO Approval:	___________________________________	Date:	___________________________________

Form # 99-S002 02/26/2008