Deferral Request Online Form

Complete this form to request a deferral from an information security procedure. For more information, see the Deferral Procedure.

Date*
MM slash DD slash YYYY
Requester's Name*
First Last
Requester's Email Address*
Requester's Phone Number*
Division or Department*
Relevant Procedure*
Scope for which a deferral is being requested*
Description of the non-adherence*
(i.e., description of the situation that is to exist if a deferral is granted)
Proposed assessment of risk associated with non-adherence*
Proposed plan for managing risk associated with non-adherence*
Additional information*
Anticipated Duration for the Deferral
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Comments
Deferral Approval
The Chief Information Security Officer will review this deferral, submit it to the Dean or Vice President (VP) of your division, and advise the Dean/VP of the risk associated with the request. The Dean/VP then approves or denies the request. The deferral is reviewed upon its expiration or as circumstances require. At any point in the process, the Chief Information Security Officer or Dean/VP may request more information about the request.
Approver's Name*
Dean or Vice President of your division
First Last
Approver's Email Address*

Anticipated Duration for the Deferral