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Course Access Request Form

Please provide the required information and submit. Once your request has been processed, you will be notified by the Registrar's Office.

PLEASE NOTE: This form allows for the selection of a single role assignment - if you are requesting on behalf of multiple users who need different levels of access, you will have to submit separate forms. If you are requesting for multiple users with the same level of access, you may submit one form.

If you are requesting to remove a user's access, please check 'Yes' in the "Removal of Access" box.

Click here for descriptions of each role.

Oath of Maimonides

Person submitting this request (Requester): *

Requester E-mail Address: *

Contact Phone Number: *

Removal of Access: * Yes No

Requesting Access For (Please provide first, middle, and last - if multiple, separate by commas - EXAMPLE: John James Doe, Jane Mary Doe): *

UMass Chan User E-mail Address (if multiple, separate by commas - EXAMPLE: john.doe@umassmed.edu, jane.doe@umassmemorial.org): *

Term: * Fall Spring

Academic Year: *

Course Name: *

PeopleSoft / BlackBoard Learn Role: *