Faculty/Staff E-Mail Account Request Form

Please print out form, fill out all information and return with the proper authorization. The form can be faxed to ext. 2244 to begin processing, however the original must be sent via interoffice mail to the ITS, room 126 @ S.R. Collins. Please allow 24 to 48 hours for completion.

Client Information:

First Name _________________________ Middle Initial ____ Last Name ___________________________________

Title ______________________________________________  Hire Date _________________

Office Location/Building ___________________________ Room # _____________________

Office Telephone # _______________________ Date Requested _______________________

Note - You will be contacted via telephone when your request has been processed

Type of Service Request

Activation:  _________

Deactivation:

Specify forwarding e-mail address: __________________________________________________________________

Changes Specify: _______________________________________________________________________________

Authorized By Department Head: _________________________________ Title ______________________________

Please Print Name Clearly: _________________________________________________________________________

IT Use Only

Client Email Address: __________________________________________________________________________________________

Completed By Administrator: ______________________________________________________________________ 

Date Completed: __________________