Human Resources, Safety & Risk Management

SF State Campus Community Member / POI Request form is required to grant non-employee access to university systems and programs. The POI request form must be approved by a sponsoring college or department Administrator/Manager or their designee.  The sponsoring College/Department and Community Member is certifying the lawful use and access of SF State University services.  The following service request will be reviewed and granted on a case by case basis by Human Resources, Safety & Risk Management, Division of Information Technology, Fiscal Affairs, Parking & Transportation department.

Date:

Administrator Requestor Name:

Company / Department / Agency:

Phone Ext:

SF State E-mail:

Complete and submit all required information below:

First Name:

Last Name:

Date of Birth: (month, day, year)

Gender: Male Female

SF State Email:

Other E-mail:

Contact phone:

SF State student?:
Yes No

SF State ID number and when:

Employed by SF State University?:
Yes No

SF State ID number and when:

Campus Service Request:

Effective Date

Ending Date

Affiliation:  

Identify / Choose your Campus / POI type:
Auxiliary-Associated Students Auxiliary-Foundation Auxiliary-Student Union Campus Guest Emeritus Faculty Emeritus Staff Exchange Faculty Dependent Retiree Visiting Scholar Volunteer Other

Other(description):