Firewall Modification Request

Firewall Modification

Request


Information Technology Services Form ITS
-
8812 Rev
E 5/27/08


Page
1

of
2




This form is
to be used for requesting modifications
to the
campus firewall
rules
so that applications can be used securely across
various zones of the network
.
If you need assistance in filling out this form, contact your

Information Technology Consultant (
ITC
)
:
http://www.calstatela.edu/itc
.
Please type or neatly print, and obtain all the required approval signatures.
I
nstructions are available at
www.calstatela.edu/its/forms
. Submit completed requests to the ITS Help Desk (LIB PW Lobby).

REQUESTOR INFORMATION

LAST NAME







FIRST NAME







MIDDLE NAME







EMPLOYEE ID NO.
(Golden Eagle Card ID #)







OFFICE LOCATION
(Bldg. & Room #)







OFFICE EXTENSION







DEPARTMENT







DE
PARTMENT EXTENSI ON







COLLEGE/DI VI SI ON







E
-
MAI L ADDRESS







I TC NAME







I TC EXTENSI ON









APPLICATION INFORMATION

(this is the application
/service

that you w
ant

to
work

over the network)

1)

Application Title
:







2)

Application Publisher
:







3)

What will the application be used for?







4)

Where do you plan on using this application?







5)

Do you currently have the requi
red license(s) for this application?


Yes


No


Will obtain license by (mm/dd/yy
yy
):






6)

Will this application be for permanent or temporary use? If temporary, provide termination date.


Permanent


Temporary

If temporary, list the termination date:






7)

What type of data will be transmitted by this application (i.e., music, graphic images, database information, text, etc.)?







8)

If applicable, list the specific file extensions.







9)

Who
/what

needs access to this application and/or files it generates?
Check all that apply
.


All Students


All
Faculty


All Staff
/Dept
Office(s)


All Open Access Labs


All Electronic Classrooms


Wireless Network


CSULA Modem Pool


CSULA Server Farm


Students in the






bui
lding


Faculty Office(s) in the






building


Staff/Dept Office(s) in the







building


Open Access Lab
(s)

in the






building


Electronic C
lassroom
(s)

in the






building


Research Office(s) in the






building


Common Management System (CMS)


Faculty Server
-

list name of server:








Staff Server
-

list name of server








Security Server
-

list name of server








O
ff Campus/Off Site

–

list hostname of site:






10)

Are User ID’s and/or Passwords req
uired to use this application?


Yes


No

11)

Will this application generate and/or store any sensitive, personal, proprietary, or confidential information?


Yes


No

12)

If yes, how
will you

secure
access to the data?







13)

Is this a new application to the campus?


Yes


No

If no, who else or what other department is using this application?






Request No.:







Firewall Modification

Request


Information Technology Services Form ITS
-
8812 Rev
E 5/27/08


Page
2

of
2




CAMPUS
SYSTEM

INFORMATION

1)

System Name (host
name)
:







2)

Name of System Owner:







3)

Where is
system
equipment located?







4)

Who has access to the equipment location?







5)

Are application

upgrades

and

system OS
patches and fixes
on a set sche
dule
?


Yes


No

If
yes
,
what is the schedule (hourly / daily / monthly / yearly)
?






NETWORK

INFORMATION

Source IP Address(es)

Source Port(s)

Destination IP Address(es)

Destination Port(s)

























Note: To get the IP Address(
e
s), you can run “
nslookup

hostname” from your command prompt where “hostname” is the name of the source and
destination hosts. To find out
specific

port(s), you

can run a port scan of the source and destination hosts to identify the port(s) required for your
application
.

The

protocol that this application uses is: (check one)


TCP


UDP

To get the protocol i nformati on,
you must b
e l ogged onto the appl i cati on server. Run “
netstat
–
a
” from
the appl i cati on server

at the command
prompt
. Look for the appl i cati on port l ocated i n the second col umn l abel ed “Local Address”. When you l ocate the appl i cation port,

the protocol will be
l i st
ed i n the fi rst col umn
l abeled “Proto”
to the l eft of the “Local Address”

col umn
.



ACADEMIC SUPPORT

(if applicable)

The ITC whose name appears on this form has contacted me about the requested software application and its use on the campus
network. I un
derstand that allowing access to this application through our campus network traffic management control may pose a
security risk to the campus network as well as to other computers. I approve of access to the requested application being al
lowed on
our cam
pus network.


D
IRECTOR
:


DATE:




APPROVED


DENIED

Reason for denial:





DEPARTMENT / BUSINESS UNIT
ACKNOWLEDGEMENTS

AND
APPROVALS

I understand that allowing access to this application through our campus network traffi
c management control may pose a security risk to
my computer as well as to the rest of the campus network. I authorize Information Technology Services to do a security vulne
rability
assessment of any system to be used for this application to identify any
system oversights that could cause security risks to the
campus.


REQUESTOR SIGNATURE:


DATE:



Dept Chair/Manager Name (type or print)







Signature


Approved

Denied

Date

Dean/Director Name (type or pr
int)







Signature


Approved

Denied

Date

If denied, give reason for denial:








Request No.: