Name of Applicant
NetID
Phone
Title
Department
Address
Official UConn E-Mail address
Details of the account will be sent to you through the mail.
Netid of individual who will be using this account:
Check one: * NEW RENEWAL CHANGE
Homepage ID * (will be assigned for new accounts)
Instructor accounts are active for the academic year.
Check Appropriate Semester Fall Spring Summer
Course Number
Please also complete the next two lines if you wish individual accounts for the students
Number of sections:
Maximum number of students per section:
New accounts are allocated 20 MB permanent disk space. Please see http://homepages.uconn.edu for additional information.
I agree to abide by the rules governing the use of computer resources. I have read Individual Responsibilities with Respect to Appropriate Use of Information Technology Resources found on http://itpolicy.uconn.edu/ . I will not allow anyone to use this account until I have determined that the individual understands the rules and agrees to abide by them.
Signature of account holder:________________________________________________________Date:___________________________
Signature of depts. dean/director:________________________________________________________Date:___________________________
Fill out, print, sign and fax to: 486-4131 or send to:
UITS Help Center / Accounts Office 196 Auditorium Road, Unit 3138 Storrs CT 06269-3138
***PLEASE DO NOT WRITE BELOW THIS LINE - FOR OFFICE USE ONLY***
