Request date:
Name:*
Phone number (password is sent via SMS):*
Email address:*
Company name or organization name:*
Company address:*
Responsible OE / Institute of the Med Uni Graz:*
ORG-Unit:
Name of the ORG leader (institute / clinic, etc.):
Email of the ORG leader (institute / clinic, etc.):
Name of IT-partner (institute / clinic, etc.):*
Note: There can be more than one IT partner per ORG unit / department / institute!
Name of IT-partner (institute / clinic, etc.):
Email of IT-partner (institute / clinic, etc.):
Name of the approver:
Email of the approver:
VPN access for (system, application) at the Medical University of Graz:*
Contact person (for system, application) at the Medical University of Graz:*
E-mail address of the contact person at the Medical University of Graz:*
Required until (standard 3 months, maximum 5 years):*
Reason for VPN access (activities):*
MEDonline account users (os_ *, op_ *, oc_ *) available
MEDonline Account Username (os_*, op_*, oc_*):
I hereby confirm that only the listed operating systems and VPN clients may be used and that these can only be supported at the listed service level.*
I hereby commit myself indefinitely, so even after I have finished working for the Med Uni Graz
Because of these obligations, I am particularly concerned with handling access rights and data
I want to ... the declaration of commitment.*
* Please note: If you cancel the process at this point, it will be completed without saving and the entered data will then no longer be available for further processing.