(N.B. You may wish to review the General Instructions and Information for the NCCS User Administration Request Form, prior to completing the form. Detailed (item-by-item) User Administration Request Form Instructions are also available to assist in the completion of this form. You may find it helpful either to read through all of the instructions before attempting to complete the form, or to read the instructions item-by-item as you complete the form. Each item of the form links to its counterpoint in the instructions.)

Section I: Type of Request

Please check only one of the three items in this section:

Section II: System Access

Section III: User Information

9.  NCCS Organization Code: _________________________________

10.  Employer: _______________________________________________

11.  NASA Badge Number: ______________________________________

     Badge Color: ____________________________________________

     Issuing NASA Center (e.g. GSFC): ________________________

If you do not have a NASA badge, enter the code N/A .

All users of NASA computing systems or information must complete mandatory basic Information Technology (IT) security awareness training. Each NASA facility is responsible for assuring that their employees and contractors have completed this training. If you do not have a NASA badge, you must complete this training through the System for Administration, Training, and Educational Resources for NASA (SATERN). See the Instructions concerning the completion of SATERN Training.

12.  Electronic Mail (e-mail) Address:

     _________________________________________________________

13.  Office Address (if on-site, include GSFC mailstop):

     _________________________________________________________

     _________________________________________________________

     _________________________________________________________

14.  User's Country of Birth:

     _________________________________________________________
     User's Current Country/ies of Citizenship:

     _________________________________________________________
     (Please list all countries of which you are a citizen.)

If you are not currently a U.S. citizen, you must also submit a Name Check Request Form (NASA Form 531). While completing the Name Check Request Form please keep the following in mind:

• The Name Check Request Form must be typed. The NASA Security Office will no longer accept handwritten forms.
• The Name Check Request Form must be mailed by postal mail at all stages of transfer. The NASA Security Office will only accept the original form with signatures. Copies of the form received by facsimile (fax) can not be processed.

Section IV: Authorizations

I, the user, have read and I do understand the provisions for non-privileged access and use of NCCS computing resources, as outlined in the NCCS Computing Resources Rules of Behavior. With my signature below I attest that I will abide by these provisions, and I certify that all information provided on this form is true and correct to the best of my knowledge.

In compliance with GSFC Procedures and Requirements (GPR) Security of Information Technology, with my signature below I further acknowledge the following:

• Unauthorized use of the computing accounts and computer resources to which I am granted access is a violation of Section 799, Title 18, U.S. Code; constitutes theft; and is punishable by law. I understand that I am the only individual to access these accounts and will not knowingly permit access by others without written approval. I understand that my misuse of assigned accounts and my accessing others' accounts without authorization is not allowed. I understand that this/these system(s) and resources are subject to monitoring and recording. I further understand that failure to abide by these provisions may constitute grounds for terminiation of access privileges, administrative action, and/or civil or criminal prosecution.

15.  __________________________________________  ____/____/20__
     User's Signature                            Date

Please obtain your Principal Investigator's signature:

16.  __________________________________________  ____/____/20__
     Principal Investigator's Signature          Date