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Information Resources  :  Organizational Units  :  Information Security

Mobile Device Registration Form


As stated in KUMC's operational protocol on "Sensitive Information in Electronic and Paper-Based Format", use of mobile devices (such as PDAs, laptops, portable hard drives and USB drives, etc.) to store or access sensitive information must first be approved by your department Chair, Dean, Director or Administrator.  If you are uncertain whether you are storing sensitive information, please review the definitions.

Once you have obtained the appropriate approval, use this form to register laptop and tablet computers, PDAs, and other portable storage devices used to store or access sensitive information.

Please fill out a separate instance of this form for each device you use to store or access sensitive information.

Asterisk (*) indicates required field.

*First Name
*Last Name
*Department
OFFICE LOCATION:
*Room Number
*Building


*Phone Number
*Email
*Type of Device
Description of Device
(if Other is chosen above)
Device Serial #
*Description of
sensitive information
to be stored
*Authorized by (name of Chair,
Dean, or Director)