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User Change Request

MADD User Change Request Form

Action to be Taken

Select User Type

Setup New UserUpdate Existing UserTerminate Current UserLeave of Absence for User

Requester Information

Requester's Name

Requester Email

User's MADD Office

Location

Type of Employee

Select Type of Employee

MADD Office EmployeeHome Office EmployeeContract EmployeeIntern / Temp

Employee Phone Number

Employee Extension

User Information

Legal Last Name

Middle Initial

Legal First Name

Preferred First Name

Department

Title

Other Title (maximum 35 characters)

Supervisor

User Needing Update

User Updates

Update to Occur

NameTitleDepartment/OfficeSupervisor

Enter New Name

Enter New Title

Other New Title

Enter New Department/Office

Enter OLD Supervisor's Name

Enter NEW Supervisor's Name

MADD Office Address

Office Number and Street Name

Office Suite Number

Office City

Office State

Office Zip Code

Home Office Address

Home Number and Street

Home Suite Number

Home City

Home State

Home Zip

New User: Salesforce Access

Please select the level(s) of access (if any) that the new user will need:

Constituent Management

VIP

Victim Services

Court Monitoring

Volunteer Management

Will this user be the primary volunteer contact for the MADD Office

YesNo

User Termination

User Name for Termination

Forward Terminated User Email to

User Leave of Absence

User Name for LOA

Enable or Disable User

LOA User Email Address To Be Sent To:

Equipment Assigned to User

Computer Service Tag

Effective Date and Time (Central Time)

Effective Date

Effective Time (Central Time)

Additional Information

Additional Requester Notes

Limit of 250 characters

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Contact Information

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