Forms

Requesting Access for Faculty & Staff

Please read the following disclaimers before continuing:

Disclaimer 1:

Please make sure that the supervisor of the User whose AD access you are requesting matches the information on UCPath. Also, make sure that the supervisor has an ACTIVE Mednet account. If the supervisor you input on the Access Request Form does not match the information on UCPath, your request will be rejected. SEMEL HR office should be able to assist in determining the correct supervisor for the user.

The UCPath supervisor inputted will need to sign off on this form. Once the AD access account is created, only the supervisor will receive the confirmation email with the login ID and default password granting the User access to the UCLA Health Systems.

Disclaimer 2:

Please inform all parties – INCLUDING THE SUPERVISOR – of any new existing access requests you are submitting for the user. Please follow up with the supervisor for updates on the status of your access request.

Disclaimer 3:

New AD user account requests require the completion of HIPAA Privacy and Information Security training. If the training is not completed at the time this request is submitted, AD account establishment will be significantly delayed. CITI HIPAA certificates are not acceptable under UCLA Health. Please ask user to visit the following link to complete the UCLA HIPAA training as soon as possible: https://uclahs.fyi/HIPAAtrainingOCR.

Acknowledgements:

Reach out!

If you require any help, have inquiries, or would like to share your thoughts with the IT team, please don't hesitate to reach out to us!

You may send an email to NPIHDesktop@mednet.ucla.edu or you can fill out this form to get in touch with one of our team members.

Disclaimer: The statements on this page represent the views of UCLA Semel Institute Information Technology and do not necessarily represent the views of the University of California, or UCLA or its Chancellor. Privacy & Terms of Use

© 2025 UCLA Semel Institute Information Technology

Attention!

Applying for mednet vpn access?

Only supervisors/managers should complete this form!

Click here to proceed

Attention!

Applying for access request with no UCPath appointment?

Enter user's name.

Please SELECT ONE of the categories below that the user belongs to.

Note: If none of these apply to you, then you should not fill out this form.

For a definition of each category, hover over here!
CATEGORY DEFINITION
Affiliate A student or staff in non-UCLA Health department.
Contractor Meets BFB-BUS-77 Independent Consultant Guidelines https://policy.ucop.edu/doc/3220485/BFB-BUS-43 https://policy.ucop.edu/doc/3600670/Independent Contractor
Collaborator User who is a student or staff in other universities and is part of an IRB.
Intern User is not enrolled in any UC campus as student. Need access to participate in training or internship.
Volunteer Registered with UCLA Health Sciences Volunteer Program https://www.uclahealth.org/volunteer/ucla-health-sciences-volunteer-program

just making sure you're not a robot

Attention!

Applying for Research careconnect access?

Please contact Semel Research CareConnect at SemelResCon@mednet.ucla.edu.