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.:
Enter the password to open this PDF file:
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-
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-
Author:
-
Subject:
-
Keywords:
-
Creation Date:
-
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