Employee Network Account Request Form

New employees must use this form to request a network/email account. After the request is received, the account will be created within 2 business days. Your username and email address will be displayed to you after you submit the form, but won’t be active until the account is actually approved and created.

User Information:

First Name:*

Middle Initial:*
_{If you do not have a middle initial use the first letter of your first name.}

Last Name:*

Job Title:*

Status:*

Department:*

Office Room Number (include building name):

Telephone Extension:

Password (minimum 6 alphanumeric characters):*

Confirm Password:*