Search
Close this search box.

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.

Attention!

Applying for mednet vpn access?

Only supervisors/managers should complete this form!

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.