Add URL to Blocked Status Form
Name: ________________________ Position: ___________________Date submitted:________
URL http://___________________________________________________________________
Primary focus of the web site: ____________________________________________________
What material is deemed objectionable: ____________________________________________
Reviewed by: _______________________ Date reviewed: _______________
Action taken:_ ________________________________________________________________
Remove URL from Blocked Status Form
Name: ________________________ Position: ___________________Date submitted:________
URL http://___________________________________________________________________
Primary focus of the web site: ____________________________________________________
Academic value of material being sought: ___________________________________________
Reviewed by: _______________________ Date reviewed: _______________
Action taken:__________________________________________________________________
Bona Fide Research/ Other Lawful Purpose Form for Disabling Internet Filtering Software
Name: ________________________ Position: ___________________Date submitted:________
Reason that requires full access to the internet with no filters:_______________________________________________________________________ ____________________________________________________________________________
Academic value of material being sought: ___________________________________________
Reviewed by: _______________________ Date reviewed: _______________
Action taken:__________________________________________________________________
I _____________________ accept the responsibility of full access to the internet for bona fide research or other lawful purposes. I understand that I am the only one authorized for full access and will not allow others to use this access for any reason. Once I am completed with this research, I will notify the administration so the filters can be reenabled.
*Adopted: 11/12/12
*Revised: 12/10/12
*Reviewed: 05/12/14
*Reviewed: 04/08/19
