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Software License Request Form

Software License Request Form

Request a new software license by documenting the business need, security review details, and procurement requirements.

Requester Information

  • Requester name
  • Requester email
  • Department
  • Manager name

Software Details

  • Software name
  • Vendor name
  • Software type
  • Number of licenses requested
  • Needed by date

Business Justification

  • Business need
  • Current workaround, if any
  • Expected benefit or outcome
  • Impact if the request is not approved

Security and Compliance Review

  • Will this software access company data?
  • Will this software store, process, or transmit PII?
  • Will this software store, process, or transmit PHI?
  • Security review notes
  • Applicable compliance requirements

Procurement and Cost

  • Pricing model
  • Estimated annual cost
  • Cost center
  • Preferred vendor or quote reference
  • Renewal or contract end date

Approvals and Additional Information

  • Additional notes
  • Supporting documents
  • I confirm the information provided is accurate and complete to the best of my knowledge.
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