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Code No. 606.2E1 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: