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Local Admin Request Form
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Full Name:
Username:
*
Email Address:
Please provide if different from Username.
Your Advisor's E-mail:
*
Room Number:
Phone Number:
Department:
- None -
AGE
BEL
CASE
CHEMS
CEE
CMSC
CO-OP
CSE
DEAN
DECS
DER
DPO
ECE
ME
UGS
Other...
Building:
- None -
EB
ERF (Jolly)
ERL (Hulet)
RCE
Farrell
Other...
Computer Name and/or IP Address:
When Computer Is On:
List days / times when computer is normally on.