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City of Rapid City Remote Access Request

Requester Information:

First Name

*

Last Name

*

Company

*

Cell Phone

*

(Phone needs to support typical 2 factor authentication apps)

Email Address

Justification / Purpose

*

Access Requested

*

(Detail specifically what server access is requested to by FQDN, Hostname, or IP address)

City Sponsor Approval:

Please provide the details for your City of Rapid City point of contact. This need be a city employee who can validate your need for remote access.

City Employee First Name

*

City Employee Last Name

*

City Employee Email

*

City Employee Telephone

*