Name
Phone
Title
Institution
Department
U-Box
University Dept #
Official UConn E-Mail address
Details of the account will be sent to you through the mail.
Any special request, or quantity of CMS cylinder space to be altered?
Enter a brief description of what this account will be used for below:
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 unless I notify the Accounts Office in writing, and determine that the individual understands the rules and agrees to abide by them.
Signature of Account Holder:________________________________________________________Date:___________________________
Name of Dept. Dean/Director(please print):________________________________________________________Date:___________________________
Signature of Dept. 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***
