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Affiliate Application Authorisation Form

This form is used for authorising affiliate privilege applications. The form will only accept authorisations from named authorisers, who will need to enter their University AD login username and password to confirm their identity.

Please note: External Examiners should not be made affiliates. They have a contract to sign before they access our systems and we only create the account when we receive a copy of that contract.

Guidance Notes: For more information on the Affiliates System, please see our Guidance Notes for Authorisers .

If you are a potential affiliate who wishes to make an application for affiliate status, please use this form instead.

Authoriser details Authoriser's login name:

Authoriser's password:

For which school or service are you authorising this affiliate?

Affiliate personal details

Title:

Forename:

Initials:

Surname:

Date of Birth:
(Required for library password. If unknown, use today's date)

Contact details of affiliate (or of partner institution/business if appropriate):

Postcode:

Contact Tel. No.:

Contact Email:

Affiliation details

Affiliate type:

Start date of affiliation (dd/mm/yyyy) (if immediate please use today's date):

End date of affiliation (dd/mm/yyyy):

Advice on the affiliate type is available from Staff IT Support, ext 3737. Use Campus Working Partner for those who don't fit into any other category.

Affiliate privileges

No affiliate type selected yet (select one above)

These are the privileges associated with this affiliate type. Most are fixed, but some are optional for some affiliate types.

Campus Card? Yes No	Network Login? Yes No	University email? Yes No If "no", please enter an email address at which the affiliate can be contacted:	SAN Space (K: L: and M: drives) Yes No
Library Access Yes No	Library Loans Yes No	Library E-Resources Yes No	Swipecard Access Yes No If "yes", swipecard access to where?

Please note that anyone applying for affiliate status must abide by the University Regulations Governing the Use of Computing Facilities.

Module number	Access level

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Affiliate Application Authorisation Form