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Data Exchange/Access Request


This form is used to request authorization of individual contacts employed by Schools, or by Third Party Service Providers, who must obtain information for loans serviced by Granite State Management & Resources (GSM&R) in order to fulfill their designated roles. Those utilizing Nsight Plus will need to obtain an electronic TFA (two-factor authentication) token from FSA to log in. *Please note by signing this document you indicate that you have read, understood and will abide by the "Agreement" found on page two of this form.

School Information:

(Character limit: 500 characters remaining)

School Contact Information: Complete this section if you are a school requesting Nsight Plus access.

  

  

  
¹Token Serial Numbers (S/N) are found on the back of each pink VeriSign token. Example: AVT123456789

School Contact Signature: ______________________________________________________________________ Date: _____________________

Authorized School Representative Approving Access: Only to be signed if the School is requesting Nsight Plus access.

  

Signature: ______________________________________________________________________________________ Date: _____________________

Third Party Service Provider Information: Complete this section if you are a Third Party Service Provider.

  
²Token Serial Numbers (S/N) are found on the back of each pink VeriSign token. Example: AVT123456789

Service Provider Contact Signature: ____________________________________________________________ Date: _____________________

Authorized School Representative Approving Request: Only to be signed if the Service Provider is requesting access.

 

Signature: ______________________________________________________________________________________ Date: _____________________

Agreement:

The School, and/or its Service Provider if applicable, as stated above, has requested that Granite State Management and Resources ("GSM&R") allow access to information connected with certain federal loans ("Loans") that are serviced by GSM&R.

Such access, whether through Nsight Plus, or through another method as prescribed by GSM&R, shall be permitted for purposes of helping to reduce the default rate for Loans made to borrower that are currently in attendance, or have at one time attended the above stated School (each, a "Borrower").

The School, and/or its Service Provider if applicable, understand and agree that GSM&R, for the purposes outlined in this Agreement for Disclosure and Use of Confidential Information (the "Agreement"), may provide access to personally identifiable information about Borrowers and their Loans and other proprietary and confidential information of GSM&R (collectively, the "Confidential Information"). GSM&R is willing to provide such information on the terms and conditions described in this Agreement. All Confidential Information provided is in accordance with the authorizations provided by Borrowers when signing the Master Promissory Note or other such loan agreement(s).

  1. The School, and/or its Service Provider if applicable, acknowledges that the information released by GSM&R shall be limited to such data or information necessary to perform the tasks within the scope of this Agreement.
  2. The School, and/or its Service Provider if applicable, agrees to provide prompt written notice to GSM&R in the event that access to the Confidential Information is no longer required. If applicable, the School agrees to provide GSM&R prompt written notice in the event that the Service Provider authority to act as the School's agent or otherwise have access to the information has changed. Such notification shall include a date on which the Service Providers access to the system and/or the information is to be terminated with GSM&R.
  3. GSM&R reserves the right to audit School, and/or its Service Providers use of the information.
  4. GSM&R reserves the right to terminate the School, and/or its Service Provider if applicable, access to the information in the event that, in its discretion, the access to the system or use of the information is inappropriate, unauthorized, illegitimate or otherwise outside the scope of the purpose outlined in this Agreement.
  5. GSM&R may from time to time request confirmation of the validity of this authorization from the School, and/or its Service Provider if applicable.
  6. The School, and/or its Service Provider if applicable, shall indemnify and hold GSM&R harmless for any costs, damages, penalties, fees or the like in the event of breach, unauthorized use or access of the system or information by the School, and/or its Service Provider if applicable.

By signing above, the School and Service Provider acknowledges and agrees to the terms and conditions above.

Email the completed form to schoolcontact@gsmr.org or fax to 603-227-5441. Once access is granted, a notification will be sent to the user's email address provided on this form.


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