Modifying Technology Protection Measures Forms
Add URL to Blocked Status Form
Name: _________________________________ Date submitted: ________________
Position: _____________________________
URL http://______________________________________________________________ ____
Primary focus of the web site: ____________________________________________________
What material is deemed objectionable: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Reviewed by: ____________________________ Date Reviewed: ________________
Action taken: __________________________________________________________________
Remove URL from Blocked Status Form
Name: _________________________________ Date submitted: ________________
Position: _____________________________
URL http://____________________________________ _______________________________
Primary focus of the web site: ____________________________________________________
Academic value of material being sought: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Reviewed by: ____________________________ Date Reviewed:_________________
Action taken: __________________________________________________________________
Disabling Internet Filtering Software for Bona Fide Research and/or Other Lawful Purpose Form
Name: _________________________________ Date submitted:_________________
Position:____________ ________________
Reason individual requires full access to internet with no filtering: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Academic value of material being sought: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
I, _____________________, accept the responsibility of full, non-filtered, access to the internet for bona fide research or other lawful purposes. I understand that I am the only one authorized for full access and will not allow others to use this access for any reason. Once I am completed with this research, I will notify the administration so the filters can be re-enabled.
_________________________________________
Signature
_________________________________________
Printed Name
_________________________________________
Date
Reviewed by: _____________________________ Date Reviewed: ________________
Action taken: __________________________________________________________________
Approved: September 29, 2015
Revised/Reviewed: February 27, 2023