Account Management – SelfDesign Support Request

Name *

First

Last

Email *

Phone

Role *

HR-IT Account Management

Please select the topic that most closely matches your inquiry.

HR Topics *

Type of Change

Contractor Name *

First

Last

Company Name *

New Name *

First

Last

Is this a new company to SelfDesign? *

Yes
No

Lead Staff Name *

Lead Staff Email *

Lead Staff Job Title *

Company Services and Deliverables

Company Phone

Company Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is the entire company being offboarded?

Yes
No

Approved staff affected by this request

Selected Value: 1

If more than ten staff are affected, please submit additional support requests

New Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Department

HR-IT Spaces Guide

Team Lead

HR-IT Spaces Guide

Contractor External Email *

Departure Date *

Type of Contract *

Primary
Additional

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is the contractor's mailing address different from their home address?

Yes
No

Mailing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone Number

Job Title

Is the new contractor an Educator? *

Yes
No

TRB Number

Hire Date *

Services and Deliverables *

Projects or Special Access

Please include any projects, permissions, or special access that the contract will require.

Is this a new role? *

Yes
No

Job Title *

Additional Details

Staff 1: Name *

First

Last

Staff 1: Email *

Staff 1: Job Title (if applicable)

Staff 2: Name *

First

Last

Staff 2: Email *

Staff 2: Job Title (if applicable)

Staff 3: Name *

First

Last

Staff 3: Email *

Staff 3: Job Title (if applicable)

Staff 4: Name *

First

Last

Staff 4: Email *

Staff 4: Job Title (if applicable)

Staff 5: Name *

First

Last

Staff 5: Email *

Staff 5: Job Title (if applicable)

Staff 6: Name *

First

Last

Staff 6: Email *

Staff 6: Job Title (if applicable)

Staff 7: Name *

First

Last

Staff 7: Email *

Staff 7: Job Title (if applicable)

Staff 8: Name *

First

Last

Staff 8: Email *

Staff 8: Job Title (if applicable)

Staff 9: Name *

First

Last

Staff 9: Email *

Staff 9: Job Title (if applicable)

Staff 10: Name *

First

Last

Staff 10: Email *

Staff 10: Job Title (if applicable)