Non University of Utah Affiliation (Consultants,Vendors,etc) Access Form Non University of Utah Affiliation (Consultants,Vendors,etc) Donor Data Access University of Utah Representative Information Statement about Non University of Utah Affiliations and Donor Data I certify that the External Entity below (individual or organization) needs access to this data for performance of their efforts on behalf of the University of Utah. I further recognize that the information provided will be used exclusively in conjunction with the completion of the organization's business with the University of Utah and no subsequent use of the information or any derivatives is authorized. I will notify the Development Office immediately in writing if the below individual or organization no longer needs access to the data, and will ensure that the third party recipient above destroys or returns copies of the information and any derivatives provided as soon as their authorized purpose has been served, or when the business relationship concludes First Name * Last Name * Title * Unid * Department/Unit * External Entity's Information First Name * Last Name * Email * Phone * Company or Organization Name Position at Company or Organization Address Address Address Address City City State/Province Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State/Province Zip/Postal Zip/Postal Relationship to University It should be noted that the type of information allowed to be shared with an external entity depends upon that entity’s relationship with the University. Those external entities that are: • Unpaid, such as a Volunteer, are only allowed access to biographical data—it is specifically not permissible for them to have direct access to giving or financial data. • Paid, such as Vendor/Consultant, may have access to any piece of information in Advance that is necessary to complete the specific task for which they are being paid. Choose Relationship Type * Volunteer Vendor/Consultant Other (Please Explain) Choose Relationship Type Describe Information Needed * Describe the Purpose of Information Needed * Requested Format * Digital Delivery/Access Media (ie: flash drive, cd, etc.) Paper Other Requested Format Is this request for System Access * Yes No Development Director Name: * Development Director Email: * reCAPTCHA Submit