User Deactivation Request

Please complete this request on (date & time): *

Date

Time

Requestor Name *

First

Last

Requestor Email *

Requestor Phone:

Full Name: *

First

Last

Username: *

Email Address: *

Employee Location: *

This section defines who should receive access to the disabled user’s files and mailbox. If left blank, their data will be archived.

Full Name:

First

Last

Email:

Phone:

Grant Access to Files?

Forward/Grant Access to Emails?

Additional Notes/Requests: