Student Staff Account Form

This form should be filled out by a dean, chair or other approved personnel.

Person Information

Legal First Name

Legal Middle Name

Legal Last Name

Date of Birth: Enter as mm/dd/yyyy. Used for matching purposes.

Off-Campus Phone: To contact regarding training.

Off-Campus Email: To contact regarding training.

Department Information

Department

Building: If no office, enter the main dept office info

Room: If no office, enter the main dept office info

Office Phone: If no office, enter the main dept office info

Account Information

Date Needed

Windows PC Login: All accounts are capable of logging into Windows PC's by default.

Macintosh PC Login: Select if the individual will use a Macintosh computer on campus.

GroupWise Email

O Drive Access: Uncheck only if you wish to remove access to the dept O drive.

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Additional Information: Enter additional information not covered above.

Requestor Information

Requestor's Name

Requestor's Email: An e-mail will be sent to the requestor.

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Student Staff Account Form

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