Incomplete fields or answering “No” to any critical information will result in a delay of the testing process or rejection. We highly recommend reviewing this form, collecting all information to fill out every field and then returning to it. Full completion of the form results in the quickest evaluation.
If this is for software intended to integrate with a UCLA Health system, please note that although UCLA Information Security Governance, Risk & Compliance provides TPRM clearance for the purchase, UCLA Health may still deny the integration request.
Attention!
Applying for mednet vpn access?
Only supervisors/managers should complete this form!