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SecureNet Classified Guest Account Request Form

User Information—Please read first

A completed form is required for all users requesting classified or restricted computer resource(s).

This interactive web page creates a printable account request form for classified or restricted SecureNet and ASC computing resources. Do not print this page as the form you send in. You must use the SUBMIT button below to generate the correct form that can be printed and sent in.

To request an account for Tri-Lab ASC (LANL, LLNL, SNL) classified computing resources, use the SNL SARAPE form. If you want to request other non-Tri-Lab ASC classified SecureNet resources or classified SNL applications, use this form.

This interactive web page uses information supplied by you to generate the form; the fields in Section I will be filled in and you will only need to get the appropriate signatures on the form before mailing it in. Don't forget to read or print the instructions for this form as necessary. (You can click on the specific linked form items for which you need assistance.)

When you have filled in the fields below, follow the next instructions carefully:

  1. Press the SUBMIT button at the bottom of the page to create the form that can be printed. This form will be displayed in a separate browser window. Use your browser's PRINT button to print out the form. Once it is printed, sign Section I on the printed form. If you are requesting Livermore Computing resources you must also sign the Livermore Computing Policies and Procedures form that is included (this is not included if you do not request LLNL resources). The printed form will be more than one page—just staple all of the pages together.
  2. Have your manager fill out and sign Section II of the printed form. Once signed and approved by your manager, send it on to the Guest Processing Agency or your host representative for authorization. Find the names of your Host Contact and Guest Processing Agency on the SecureNet Host Contacts and Guest Processing Agencies Web page. 

The Guest Processing Agency will complete Section III and send it on to the Host Processing Agency at the site where you requested ASC resources for final processing and authorization. You can use the SecureNet Host Contacts and Guest Processing Agencies Web page to locate your HPA representatives.  If you are unclear about where the form is to be sent, check with your host contact.

Reminder: Your request cannot be processed until the completed, signed form has been processed and authorized by both Guest and Host Agencies.

GUEST INFORMATION
Name: Phone #:
Site Name:
Honeywell FM&T/KC DOE/ABQ DOE/HQ INEEL LANL LLNL   PANTEX
SNL/NM SNL/CA SRS Y12
Guest Organization (or Group): SSN:
Mailing Address:
Unclassified Email Address:   Mail Stop:
Classified Email Address: Citizenship:
Date of Birth:
Classified Kerberos or OTP Username (at guest's site):  
Classified Kerberos Realm (at guest's site): LANL Secure LLNL Sandia
        Other - specify:
Primary Computer: IP Address:
HOST ACCESS INFORMATION
Host Site Name:
Honeywell FM&T/KC LANL LLNL PANTEX SNL/NM SNL/CA SRS Y12
Contact Name (for host resources):
Phone #:

Requested Resource(s): Check the resource box(s) from the host site list below:
Honeywell FM&T/KC LANL LLNL Y12
Excalbia
To request non-ASC resources,
use the Other resource field below.
LANL Users only, please submit if known:
Z Number (LANL ID):
Project Name or Brief Description:
To request non-ASC resources,
use the Other resource field below.
To request Y12 resources, fill out and include the Y-12 SecureNet Resource Access Request Form and the User Security Agreement for Classified Computing Resources when you send in your request.
PANTEX SNL/NM SNL/CA SRS
PACMAN Classified IMS
NWC Hub
WIMPS

Other resource:
Requested Username
(12 characters or less):
Sigma Levels (put 'don't know' if you don't know):

 

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Last modified on November 16, 2012