Sponsored Account Request Form
Use this form to request a sponsored account and provide the information needed for UMSI review, screening, approval, and account creation.
Sponsor & Identity
Your Name
*
First Name
Last Name
Your Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Sponsor requestor affiliation
*
Please Select
UMSI Faculty
UMSI Staff
Visitor Personal & Eligibility Information
Name
*
First Name
Last Name
History of University affiliations
Sponsored
Student
Faculty
Staff
Other
UMID (if known)
Uniqname (if existing)
Non-U-M email address
*
example@example.com
Business justification
*
Is this a request to get access to data owned by the above person?
Please Select
Yes
No
Date of birth
*
-
Month
-
Day
Year
Date
U.S. citizen or permanent resident?
*
Yes
No
Unsure (HR will ask)
Other citizenship / visa information
Employer or home institution
*
Employer title
*
Highest degree earned
Please Select
High school
Associate degree
Bachelor's degree
Master's degree
Doctorate
Professional degree
Other
Visitor Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current Visitor Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What is the highest level of education of the visitor?
Visit Details
Visit mode
*
In-person
Remote
Combination
Visit type
*
Please Select
Covered Visiting Researcher/Scholar
Covered Visiting Student
Covered Visiting Affiliate/Colleague
Visit start date
*
-
Month
-
Day
Year
Date
Visit end date
*
-
Month
-
Day
Year
Date
U-M location or remote work site
*
Associated project grant status
Please Select
Funded
Pending
Not applicable
Other
Description of work to be performed
*
What non public resources does this visitor need access to
*
Funding, Screening & Compliance
Source of Funding
*
Please Select
Employer/Home Institution
Fellowship
Grant Award
Self-Funded
Other
Funding Details (fellowship name, grant award, or employer/institution name)
Research Approval & Notifications
Research participation requires PI review and confirmation of applicable research agreements, grants, and contracts
*
Yes
No
Your signature: I understand my requirements under this policy.
*
Submit
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