Azure Access Request

This form is for a department head or someone similar to request access as well as the creation of an Azure subscription for their college/department and set up billing. The VM request form is used to request and set up billing for a hosted VM in our data center. This form allows you to create their own datacenter in the cloud. You can spin up any number of VMs if you want. These could be used for web hosting or functions or web apps etc.

Azure Subscription Request Form

  • Contact Information for Azure Subscription Owner

  • Name * Required
  • Account Information

  • Should be entered as UIC-[Department Name]. This will be used to name your subscription. If you'd like to add anything to your subscription name please add it here. For example, your subscription could be named “UIC-English-DRBProject”
  • ACCC must configure network equipment on premise as well as in Azure to secure and route your connections between Azure and your local network resources. Please enter the VLANs/Subnets that are under your departments control (e.g. 10.9.4.0/24). If you're unsure of what VLANs are allocated to your department, please contact your departmental IT staff to determine your IP space (including workstations). Be sure to indicate which campus networks are reachable externally (i.e. off campus). This helps us ensure that resources on the Campus network are routed properly to Azure. NOTE: Be sure to include your AnyConnect VPN address space as well.
  • Unit Information Security Officers (UISOs): Please enter in the form any NetIDs. You may enter more than one NetID.
  • Please enter the email addresses of the people who should be copied on the monthly billing statement and/or CC-ed on billing questions.
  • FORMAT: chart - fund -organization - account (xx)- program - activity - location (please fill any missing/optional fields with 0's)
  • What is the highest risk data sensitivity that this subscription will use * Required
    Please review the security program documentation for information about data classification: NOTE: A completed Cloud Risk Assessment spreadsheet must be completed for all applications placed in Azure. For example, separate risk spreadsheets must be completed for a web site/service in Azure and a research computing application.
  • EULA

  • This field is for validation purposes and should be left unchanged.