Oracle User Administration
Form A State Role Request

Fill out the form below to request IDs or Roles.

Requester's Information:
First Name	* (required)
Last Name	* (required)
Work Phone	* (required)
E-mail	* (required)
User's Information:
First Name	(enter "same" if name, phone and address are same as requester)
Last Name
Work Phone
E-mail
Department
Position
ID Type	STATE_USER
User's Existing Oracle ID

Form A ROLE REQUESTED:

	FORM_A_EDIT

There is a 48 hour turnaround time on id and role requests. You will receive an email notification when the id/roles are completed. If you have any questions, please call the NAIC Help Desk at (816) 783-8500 or email at help@naic.org