Security Form - OS Exemption Request

Your Contact Information

Use the Sign In link in the top right to sign in before filling out this form to view your request once submitted. When you are signed in, your name and contact information will automatically be included with your request. If you do not have a Pitt account, fill out your name and contact information on this form.
The requestor's preferred phone number for follow-up contact.

Request Details

Senior Administrator who is ultimately responsible at the Director level
Technical contact who is responsible for daily operations and maintenance

Date Requested

When the exemption should start
The last date the exemption should apply.

Host Information

Host 1

The host name of exempted machine, first row.
The IP address of the exempted machine, first row.
The VLAN for the exempted machine, first row.
The operating system of the exempted machine, first row

Host 2

The host name of the second exempted machine
The IP address of the second exempted machine
The VLAN of the second exempted machine.
The operating system of the second exempted machine.

Host 3

The host name of the third exempted machine.
The IP address of the third exempted machine.
The VLAN of the third exempted machine.
The operating system of the third exempted machine

Host 4

The host name of the fourth exempted machine
The IP address of the fourth exempted machine.
The VLAN of the fourth exempted machine.
The operating system of the fourth exempted machine.

Host 5

The host name of the fifth exempted machine.
The IP address of the fifth exempted machine.
The VLAN of the fifth exempted machine.
The operating system of the fifth exempted machine.
The name of the vendor requiring the exemption
The kind of data on the exempted (machines).
Application, hardware, or service exemption.
Is the exempted machine internet facing?
Does the exempted machine have sensitive data?

Other Fields

Your name
Verification Code