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City of Santa Ana <br /> <br />Attachment A <br />ELECTRONIC MAIL <br />Authorization for Special Access <br />(Please Print) <br /> <br />Please allow special access to the City of Santa Ana’s electronic mail system for the following <br />employee/contractor. <br /> <br />Employee’s/Individual Name <br />Effective Date <br /> <br />Authorization Name (Executive Director) <br />Today’s Date <br /> <br /> <br />I, the undersigned, certify that I am the Executive Director for the above named <br />employee/individual: <br /> <br />Executive Director’s Signature <br /> <br /> <br /> <br />Executive Director’s Name <br /> <br />(print) <br /> <br /> <br />Agency/Department <br /> <br />Phone Ext. <br /> <br />Date <br /> <br /> <br />Please submit this completed form to: City Electronic Mail Administrator <br /> Information Services Division <br /> Phone extension: 5416 <br /> <br />For Internal Use Only <br />(Please do not write below) <br /> <br />Date Received ______________________ Date Access Granted <br />_______________________ <br /> <br />Comments <br />___________________________________________________________________ <br />___________________________________________________________________________ <br />_ <br /> <br /> 3 <br /> <br />