Submit a request – Department of Medicine IT Helpdesk

Please choose your issue below

Your email address

Subject(optional)

Please give us a brief description

A member of our support staff will respond as soon as possible.

Termination Full Name

Enter full name of terminated employee (with middle initial)

Division, Department, Center or Institute

NOTE: Please select appropriate Division - NOT just Department of Medicine (this is for Education, Communications, ORS, Finance, or Operations)

Last Day of Work

At close of business on the last day of work DOM login and access will be set to inactive status.

Employee ID (optional)

An Employee ID is a unique 8-digit number assigned to UW employees when their initial appointment begins.

Last Day on Payroll(optional)

The last day the employee will be paid through DDEEA payroll.

Is the Employee Leaving University?(optional)

Building Access(optional)

Should building access rights (HSLC/CSC/MFCB/WIMR/MSC) be deactivated?:

Term HR Comments(optional)

Provide additional information regarding the termination.

Termination Continuing with UW(optional)

Where is the employee transferring to a new position within the UW System?:

Attachments(optional)

Add file or drop files here