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SOP - Data Use Agreement
SOP - Data Use Agreement
SOP - Data Use Agreement
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Title
A short description to explain the nature of a ticket.
Customer Information
Requested on behalf of
Requested on behalf of
Myself
Someone Else
Requesting for someone else
Please make sure to update the "Requested For" field to their name.
Ticket Details
Do you need access to Tier 3 sensitive information?
After reviewing the memo on sensitive information classification and consulting with your supervisor, please indicate if you will have access to any category of tier 3 sensitive information to fulfill your role at the UNC Eshelman School of Pharmacy. If you select ‘yes,’ you’ll be asked to select specific categories.
Do you need access to Tier 3 sensitive information?
Yes
No
Categories of sensitive information
Categories of sensitive information (required)
SSN
FERPA
IIHI
PII
Signature
By checking this field and submitting this form you attest to having read and understood the above statements and provide your digital signature affirming this attestation.
Signature (required)
I attest to the above statements.
Additional information
Please add any additional information you think will be helpful in getting your request resolved.
Press Alt + 0 within the editor to access accessibility instructions, or press Alt + F10 to access the menu.
Other Fields
Your name
Your first name
Your last name
Your email address
Your phone number
Verification Code