Request for Access to the Staff/Faculty Extranet

First Name: *
Last Name: *
Position Title:
Full Time or Part Time:
Department: *
Faculty: *
Building and Room:
Phone Extension: *
Western Email ( *
Unit Head:
Course(s) being taught:
* mandatory

By clicking the submit button the REQUESTOR understands and accepts the responsibilities outlined in the University of Western Ontario Policies and Procedures "Code of Conduct re: University Data and Physical Resources" No. 1.13

  • It is your responsibility to treat the sensitive personal information you get from the Staff/Faculty Extranet as confidential.
  • Please be diligent of the physical safety of this personal information.
  • Be sure to shred paper copies and delete older files that are no longer required.
  • Always ensure that there is adequate means to secure this data if you are transferring this data onto other devices.