NETWORK ACCESS REQUEST FORM
If you have questions, email email@example.com or call 256-824-3333.
PERSON RESPONSIBLE FOR DEVICE
Name (Or Sponsor if Student)
Campus Mailing Address
Campus Email Address
Campus Phone Number
Device Location(s) (both new and old for relocation)
MAC Address (Physical Address)
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
Network Access Request Form
4 March 2014
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