Forms LibraryInformation Services


Information Services uses IBM's Tivoli Identity Management (ITIM) system to request access to UTMB's information resources. Except for the instances below, access requests will be made via ITIM by the department's trusted requestor. If you do not know who your trusted requestor is, click here to look up your trusted requestor.

Requesting Access if ITIM is unavailable - if ITIM is not available and a trusted requestor has an emergency request, contact the Service Desk at ishelp.utmb.edu or call (409)772-5200. A ticket will be created and Access Management will be paged. Please include the user's name and what access is needed. IS will only respond to these requests if they are made by a Trusted Requestor (TR). After ITIM is back online, the TR will need to go online and make the same request. This information is needed for automation and audit purposes.

Clinical Forms

ISSA Security Load Form

Miscellaneous Forms

For Information Services employees only - Mobile Device Allowance (Webform) - Eligible IS employees who have a documented official state business need for a mobile communication device will be eligible to recieve the moblie communication device acquisition allowance(s).

Loan Agreement (Webform) - Operations is responsible for tracking all mobile leased equipment. Please fill out the IS Leased Asset Loan Form Agreement for each device in your posession.

Trusted Requester Authorization Form
- This form serves as documentation for who is authorized to sign as a Trusted Requester for your department on issues related to Information Resources.

Patient Care Systems Change Request Form
- used to interactively request changes in patient care systems.


Non-Disclosure Forms

UTMB Employee Nondisclosure - The University of Texas Medical Branch at Galveston Information Resources Security Acknowledgement and Nondisclosure Agreement form for UTMB Employees

Non UTMB Employee Nondisclosure
- The University of Texas Medical Branch at Galveston Information Resources Security Acknowledgement and Nondisclosure Agreement Form for Non-UTMB Employees and Visiting Students

Student Nondisclosure
- The University of Texas Medical Branch at Galveston Information Resources Security Acknowledgement and Nondisclosure Agreement for UTMB Students.