Affiliate Status Request Form

Name of Requestor(Required)

First Last

Requester Email(Required)

Affiliate/Visitor Name(Required)

Please note it can take 2-3 weeks for affiliate status to be set up and approved.

First Last

Request Type(Required)

Affiliate Email(Required)

IF the affiliate or visitor has a previous relationship with BSU as a student, employee, or previous affiliate or visitor, please enter Boise State ID (if known)

Start Date(Required)

MM

DD

YYYY

End Date(Required)

MM

DD

YYYY

Status Requested(Required)

Affiliate/Visitor Roles and Responsibilities(Required)

(Be specific, attach additional sheet if needed)

Roles and Responsibilities file if needed

Max. file size: 10 MB.

Will the Affiliate/Visitor need any of the following?(Required)

Ctrl + click to add multiple

What specific drives need to be added to computer?

What office space will the affiliate occupy?

Other explanation

Please include funding string for any charges for the above

(Funding string for ID card required otherwise local account will be charged)

As the submitter, it is your responsibility to inform the affiliate to watch for an email from Sterling Infosystems to approve a background check.(Required)

Yes, I will notify the affiliate

The following information is needed to complete the request but due to the nature of personal information, it needs to be emailed to susanhamblin@boisestate.edu:(Required)

I confirm that address, phone number, date of birth, and last 5 digits of Social Security have been emailed to susanhamblin@boisestate.edu

Affiliate Status Request Form

Affiliate Status Request

GEOSCIENCES