Information Technology Termination Request
Fill in appropriate fields,
Today's Date *
MM
/
DD
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YYYY
Requester Name *
Your answer
Employee Information
First Name *
Your answer
Last Name *
Your answer
Type of Termination *
Scheduled Termination Date
please disregard if an immediate termination
MM
/
DD
/
YYYY
Time
:
Security Information
Disable Network Account *
Forwarding *
Please select all items that need to be forwarded to another employee(s)
Required
Forward Email to whom?
Your answer
Forward Phone to whom?
Your answer
Forward Voice Mail to whom?
Your answer
Retrieve Computer Data *
Who needs access to the data? *
Your answer
Hardware and Software Information
What types of IT assets need to be recovered &/or reformatted? *
Please select all that apply
Required
When can computing asset be picked up and configured for redistribution?
MM
/
DD
/
YYYY
Additional Comments
Your answer
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