NETWORK ACCESS REQUEST FORM

If you have questions, email helpdesk@uah.edu or call 256-824-3333.

REQUEST TYPE
New Workstation
New Server
Relocate Device
Change Device Ownership
Delete IP Address
Change NIC
Surplus

PERSON RESPONSIBLE FOR DEVICE

Device Registrant (Or Sponsor if Student)

 

 

Department

 

 

Campus Mailing Address

 

 

Campus Email Address

 

 

Campus Phone Number

 

 

Form Submitter's Email Address

 

 

EQUIPMENT INFORMATION

Device Type

 

 

Device Location(s) (both new and old for relocation)

 

 

Operating System

 

 

MAC Address (Physical Address)

 

 

Need help finding the machine's MAC address? Click here for instructions.

NODE NAME INFORMATION

Note: Network Services reserves the right to assign node names. The following request will be honored if possible.

Internet Node Name (System Name)

 

 

Domain Name (If other than uah.edu)

 

 

Internet Address (for Change or Delete IP Address)

 

 

In making this application for computing resources I hereby consent to the monitoring of my usage of these computing resources for the purpose of detecting unauthorized use and accounting. I further understand that any unauthorized usage would make me subject to disciplinary action and/or criminal prosecution. I acknowledge that I have read the UAH Computer Security and Usage Policy and agree to its terms.

 

UAH Office of Information Technology

Revised

oit.uah.edu

Network Access Request Form

4 March 2014

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