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SecureWeb Site Enrollment Form

Request a SecureWeb scan for your new Website. Please provide all information requested.

Your Contact Information

University Computing Account Username    Invalid Username
Name * First Name Last Name Invalid Name	Phone *  -  - Invalid Phone Number
Email * Invalid Email	Department  Department Required
Room  Room Required	Building  Building Required
Affiliation * Please select Student Faculty Staff UPMC Applicant Other Affiliation Required	Campus Please select Pittsburgh Bradford Greensburg Johnstown Titusville Campus Required

Business Attributes

Production URL *    Production URL required (Web address used when site goes live)

Development URL *    Development URL required (Web address used for development of the site)

Site Description *     Site Description required  (Please describe the purpose of this site. Is this site considered Critical to your operations?)

Payment Transactions   (Does your site facilitate payments?)

Sensitive Data   (Does your site process private or restricted data as defined by the Data Risk Classification https://www.technology.pitt.edu/security/data-risk-classification-and-compliance?)

IRB Number    (Institutional Review Board protocol number, if applicable)

Site Owner Name *    Site Owner Name required (The person ultimately responsible for the content of the site)

Site Owner Email * Invalid Site Owner email

Site Owner Phone (Day) *  -  - Invalid Site Owner Phone (Day)

Site Owner Phone (After Hours) *  -  - Invalid Site Owner Phone (After Hours)

Technical Attributes

Content Management System *  --Select one-- None Word Press Drupal Joomla DotNetNuke CMS Made Simple PHP-Nuke Other (Specify)...  Content Management System required

Content Management System (Specify)

Website Language *   Please check at least one Web Site Language HTML Java .NET Perl PHP Python Ruby ColdFusion NodeJS Javascript Other (Specify)...

Website Language (Specify)

Database

Database IP Address

Website User Logon    (Does the site require non-admin users to authenticate?)

Primary Technical Contact Name *    Primary Technical Contact Name required (Primary person responsible for the support of the site)

Primary Technical Contact Email * Invalid Primary Technical Contact email

Primary Technical Contact Phone (Day) *  -  - Invalid Primary Technical Contact Phone (Day)

Primary Technical Contact Phone (After Hours) *  -  - Invalid Primary Technical Contact Phone (After Hours)

Secondary Technical Contact Name

Secondary Technical Contact Email Invalid Secondary Technical Contact email

Secondary Technical Contact Phone (Day)  -  - Invalid Secondary Technical Contact Phone (Day)

Secondary Technical Contact Phone (After Hours)  -  - Invalid Secondary Technical Contact Phone (After Hours)

* Required